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. 2021 Nov;15(4):460-473.
doi: 10.1177/2049463721992091. Epub 2021 Feb 18.

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

Neil Smith  1   2 , Ziheng Liew  1 , Samantha Johnson  1 , David R Ellard  1 , Martin Underwood  1 , Rebecca Kearney  1
Affiliations

A systematic review of the methods and drugs used for performing suprascapular nerve block injections for the non-surgical management of chronic shoulder pain

Neil Smith et al. Br J Pain. 2021 Nov.

Abstract

Suprascapular nerve block (SSNB) injections are growing in popularity as a treatment option for people with chronic shoulder pain. The optimal method of injection and aftercare is unknown. This review describes the current methods and drugs used for performing SSNB injections in the non-surgical management of adults with chronic shoulder pain in order to inform future research in this area. Systematic searches of CINAHL, MEDLINE (OVID), AMED, Embase databases and the Cochrane Library were undertaken from inception to June 2020. Data on the method and drugs used for injection and aftercare were extracted and summarised for areas of commonality and discrepancy. We included 53 studies in this review. In total, eight different injection methods were reported within the included studies. Indirect surface land-marked methods were the most common method reported in 21 studies. Direct surface land-marked methods were reported in 12 studies. Ultrasound-guided methods used alone were reported in 16 studies. Both fluoroscopy and computed tomography methods used alone were reported in one study each. Electromyography was used in combination with other injection methods in nine studies. Wide variation in the composition of the injectate was observed between studies. Local anaesthetic was used within injectate preparations in all studies. Local anaesthetic used alone was reported in 20 studies, combined with steroid in 29 studies and combined with various other components in 5 studies. Physiotherapy following injection was reported in 26 studies. Reported details of physiotherapy varied considerably. This review identified substantial variation in the methods and drugs used to perform SSNB injection in clinical trials. Current literature demonstrates a wide range of methods used for SSNB injection administration. Consensus research defining standardised practice for SSNB injection is now needed to guide future clinical practice and research.

Keywords: Suprascapular nerve block; shoulder pain.

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Conflict of interest statement

Conflict of interest: The author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: N.S. is currently undertaking a National Institute for Health Research (NIHR) Pre-doctoral Clinical Academic Fellowship. R.K. is a chief investigator or co-investigator on multiple previous and current research grants from the UK NIHR, Arthritis Research UK and is a co-investigator on grants funded by the Australian National Health and Medical Research Council (NHMRC). She is also a member of the UK NIHR Health Technology Assessment (HTA) Clinical Evaluation and Trial (CET) board, NIHR Integrated Clinical Academic (ICA) Doctoral panel, chair of the NIHR Research for Patient Benefit (RfPB) board and holder of an NIHR Fellowship award. M.U. is a chief investigator or co-investigator on multiple previous and current research grants from the UK NIHR, Arthritis Research UK and is a co-investigator on grants funded by the Australian NHMRC. He is an NIHR senior investigator. He has received travel expenses for speaking at conferences from the professional organisations hosting the conferences. He is a director and shareholder of Clinvivo Ltd that provides electronic data collection for health services research. He is part of an academic partnership with Serco Ltd, funded by the European Social Fund, related to return to work initiatives. He is a co-investigator on three NIHR-funded studies receiving additional support from Stryker Ltd. He has accepted honoraria for teaching/lecturing from Consortium For Advanced Research Training In Africa. Until March 2020, he was an editor of the NIHR journal series, and a member of the NIHR Journal Editors Group, for which he received a fee. He has published multiple papers on painful disorders some of which are cited in this paper. D.R.E. and R.K. are the co-investigators on multiple previous and current research grants from the UK NIHR. S.J. reports no conflicts of interest. Z.H. reports no conflicts of interest.

Figures

Figure 1.
Figure 1.
Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow chart.
Figure 2.
Figure 2.
Summary of injection methods used in studies included. CT: Computed Tomography; US: Ultrasound; SGN: Spinoglenoid notch; EMG: Electromyography.
Figure 3.
Figure 3.
Trend in method used for SSNB injection since 2010. SGN: Spinoglenoid notch; EMG: Electromyography; US: Ultrasound.
Figure 4.
Figure 4.
Summary of medications used within studies included.
Figure 5.
Figure 5.
Summary of injectates.
Figure 6.
Figure 6.
Mean dosage of local anaesthetic used in mg for guided and landmarked Bupivacaine and Lidocaine medications.
See this image and copyright information in PMC

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