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We read with interest the article by Shanahan et al  on
suprascapular nerve blocks and the accompanying editorial by Hall and
Buchbinder . It is gratifying to know that in this context the indirect
method of needle placement produces a similar outcome to the
radiologically-guided method. However, we would like to point out an
important methodological flaw in the study.
The patients who received injections via the landmark approach were
injected with 40mg of methylprednisolone and 10 mls of 0.5% bupivacaine,
whereas those who underwent CT-guided injection received 40mg of
methylprednisolone and 3 mls of 0.5% bupivacaine. Previous studies have
shown that suprascapular nerve blocks produce effective analgesia for a
variety of painful shoulder conditions, including frozen shoulder ,
rotator cuff lesions , and rheumatoid arthritis . Fundamentally,
however, in a double-blind study of 58 rheumatoid shoulders, suprascapular
nerve block with bupivacaine alone has been shown to be as effective as
bupivacaine plus methylprednisolone at improving pain, stiffness, and
range of movement . The authors of this study concluded that the
addition of methylprednisolone conferred no additional benefit.
Thus, if one concludes from this that the local anaesthetic is the
active ingredient, Shanahan’s two patient groups were given different
doses of the same drug (10 mls compared with 3 mls). Consequently the
study may have underestimated the effect of the CT-guided approach.
(1). Shanahan EM, Smith MD, Wetherall M et al. Suprascapular nerve
block in chronic shoulder pain: are the radiologists better? Ann Rheum Dis
(2). Hall S, Buchbinder R. Do imaging methods that guide needle
placement improve outcome? Ann Rheum Dis 2004;63:1007-1008
(3). Dahan TH, Fortin L, et al. Double blind randomized clinical trial
examining the efficacy of bupivacaine suprascapular nerve blocks in frozen
shoulder. J Rheumatol. 2000 Jun;27(6):1464-9.
(4). Vecchio PC, Adebajo AO, Hazleman BL. Suprascapular nerve block for
persistent rotator cuff lesions. J Rheumatol. 1993 Mar;20(3):453-5.
(5). Emery P, Bowman S, et al. Suprascapular nerve block for chronic
shoulder pain in rheumatoid arthritis. BMJ. 1989 Oct 28;299(6707):1079-80.
(6). Gado K, Emery P. Modified suprascapular nerve block with
bupivacaine alone effectively controls chronic shoulder pain in patients
with rheumatoid arthritis. Ann Rheum Dis. 1993 Mar;52(3):215-8.