Abstract
Fracture of the scapular is uncommon but painful. A case is described in which a comminuted scapular fracture was treated with a continuous suprascapular nerve block. With the patient lying supine an epidural needle was directed towards the scapular notch via a superior approach and an epidural catheter was placed when the notch was believed to have been identified. Repeat injections of 10 ml bupivicaine 0.25 per cent with 1/200,000 epinephrine provided analgesia within minutes and a duration of 8–10 hr. Injection of 10 ml radio-opaque dye demonstrated the catheter to be lateral to the scapular notch. However, dye dispersed throughout the suprapinous fossa including the scapular notch thus blocking the suprascapular nerve. This case demonstrates that continuous suprascapular nerve block can be performed for five days and that location of the scapular notch is less important than previously thought.
Résumé
Quoique rare, la fracture comminutive de l’omoplate n’en est pas moins très douloureuse. Nous en avons traité un cas avec un bloc continu du nerf sus-scapulaire. Avec le patient en décubitus dorsal, nous avons visé l’échancrure coracoïdienne par une approche supérieure et y avons glissé un cathéter épidural. Des injections répétées de bupivacaïne 0,25 pour cent avec adrénaline 1/200 000 ont procuré une analgésie débutant en quelques minutes et se prolongeant de 8 à 10 hre. Linjection de 10 ml de médium radio-opaque, tout en demontrant que le cathéter était en externe de l’échancrure, a permis de voir que toute la fosse sus-épineuse en était couverte jusqu’ à l’échancrure coracoïdienne où passe le nerf sus-scapulaire. Il est done possible de faire un bloc continu du nerf sus-scapulaire pendant cinq jours et que pour ce faire, la localisation de l’échancrure coracoïdienne n’est pas aussi importante qu’estime autrefois. Scapular fracture is an uncommon but painful injury which is frequently associated with injuries involving the thorax and craniospinal axis. We report a case of chest trauma where continuous suprascapular nerve block was used to provide analgesia for a comminuted scapular fracture.
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Breen, T.W., Haigh, J.D. Continuous suprascapular nerve block for analgesia of scapular fracture. Can J Anaesth 37, 786–788 (1990). https://doi.org/10.1007/BF03006537
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DOI: https://doi.org/10.1007/BF03006537