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Infraspinatus-teres minor (ITM) interfascial block: a novel approach for combined suprascapular and axillary nerve block

Authors
 Shin Hyung Kim  ;  In-Seung Yeo  ;  Jaewon Jang  ;  Hyun Eom Jung  ;  Yong-Min Chun  ;  Hun-Mu Yang 
Citation
 REGIONAL ANESTHESIA AND PAIN MEDICINE, Vol.49(1) : 67-72, 2024-01 
Journal Title
REGIONAL ANESTHESIA AND PAIN MEDICINE
ISSN
 1098-7339 
Issue Date
2024-01
MeSH
Axilla / innervation ; Brachial Plexus* / anatomy & histology ; Cadaver ; Humans ; Nerve Block* / methods ; Rotator Cuff / surgery ; Shoulder Joint* / diagnostic imaging ; Shoulder Joint* / innervation ; Shoulder Joint* / surgery
Keywords
Nerve Block ; Ultrasonography ; analgesia
Abstract
Background: Combined suprascapular and axillary nerve block could be an analgesic option for shoulder pain control. The current description of this technique requires performing the block procedures at two different sites without consideration for catheter placement. We hypothesized that a single site injection to the interfascial plane between the infraspinatus and teres minor would result in an injectate spread to the suprascapular and axillary nerves.



Methods: We performed 10 injections with this approach using 25 mL dye solution in 10 shoulders of five unembalmed cadavers. Also, we described three case reports, two single-injection cases and one catheter-placement case, using this approach in patients with acute postsurgical pain and chronic pain in their shoulder region.



Results: In cadaveric evaluations, dye spreading to the suprascapular nerves on the infraspinatus fossa and the spinoglenoid notch cephalad and axillary nerves in the quadrilateral space caudally were observed in all injections. In addition, the most posterolateral part of the joint capsule was stained in 8 out of 10 injections. There was no dye spreading on the nerves to the subscapularis or lateral pectoral nerves. Clinically successful analgesia with no adverse events was achieved in all three cases.



Conclusion: Our anatomical and clinical observations demonstrated that an injection to the interfascial plane between the infraspinatus and teres minor consistently achieved injectate spreading to both suprascapular and axillary nerves, which innervate the glenohumeral joint.
Full Text
https://rapm.bmj.com/content/49/1/67.long
DOI
10.1136/rapm-2023-104738
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anatomy (해부학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Yang, Hun Mu(양헌무) ORCID logo https://orcid.org/0000-0003-1954-0114
Jang, Jaewon(장재원) ORCID logo https://orcid.org/0000-0002-1997-8733
Jung, Hyun Eom(정현엄)
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/198547
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