Considerations for the Suprascapular Nerve Block

The suprascapular nerve provides sensory innervation to the glenohumeral joint (shoulder) which makes it an effective block for managing pain and disability in certain chronic shoulder pain conditions.

The suprascapular nerve block is also indicated for relief of acute shoulder pain e.g., after shoulder surgery and is more effective when combined with blockade of the axillary nerve. But why not just perform an Interscalene block, the gold standard for shoulder surgery? Noted authorities clearly answer this question.

While the Interscalene nerve block performs well in healthy patients, patients with preexisting compromised cardiorespiratory function, such as COPD, can present difficult consequences like being on a ventilator until the diaphragm recovers.

Studies show when performing an interscalene block even small amounts of local anesthetic can spill over the anterior scalene muscle, blocking the phrenic nerve causing hemidiaphragmatic paralysis (HDP).

Another worldwide major heath concern in recent years is obesity. This subset of patients present many of the same significant physiological changes in the airway, the respiratory and the cardiovascular systems. Regional anesthesia is considered more advantageous than general anesthesia in obese patients, when applicable.

What is the answer? Dr. Jeff Gadsden, Duke University suggest the best option is to perform a block more distal to the plexus such as the suprascapular nerve block combined with the infraclavicular nerve block, or the suprascapular nerve block combined with the axillary nerve block. For more information watch Phrenic-sparing Shoulder Blocks: Suprascapular and Axillary Nerve Blocks (

Another great resource is Dr. Admir Hadzic, Anesthesiologist and Director of NYSORA. In this video, Diaphragm-Sparing Blocks for Shoulder Analgesia, Dr. Hadzic answers questions that have come directly from NYSORA Course attendees.

Valkyrie offers both the Surpascapular, model MS2-SSC, and the Infraclavicular, model MS2-INF ultrasound guided regional nerve block simulators.

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