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Suprascapular block
Key Points
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High-frequency, 38-mm broadband linear array transducer is preferred for this block.
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For catheter insertion, the Tuohy needle is usually used. The catheter is placed beneath the transverse scapular ligament around the suprascapular nerve (SSN). The correct position of the catheter can be confirmed under ultrasound by injecting either local anesthetic or 1 mL of air via the catheter and observing its distribution in relation to the SSN and the transverse scapular ligament.
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The incidence of pneumothorax associated with SSN block is reported as less than 1%. The use of ultrasound and the in-plane approach will decrease this risk markedly.
Sonoanatomy
The SSN arises from the C5 and C6 nerve roots, emerges from the superior trunk of the brachial plexus, and then enters the supraspinatus fossa via the suprascapular notch underneath the superior transverse scapular ligament. With application of color Doppler, the SSN can be visualized medial to the pulsation of the suprascapular artery as an oval or round, slightly hyperechoic structure. In the supraspinous fossa, the nerve is in direct contact with bone and exits the suprascapular fossa lateral to the infrascapular fossa and lateral to the spinoglenoid notch ( Fig. 7.1 ).
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