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Name | Comparative study of use of Bupvicain, Bupvicain with methyl prednisolone and only normal saline to block suprascapular nerve in chronic shoulder pain- A study of 90 cases. |
Description | Research article:-Orthopaedics Salgia Anil1*, Agarwal Tushar2,Biswas S. K3,Sanghi Sahil4 & Sachdev Abhishek4.
1Professor,2Assistant Professor,3Professor & HOD,4Resident,Department of Orthopaedics, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pimpri, Pune 411018.India.
Abstract: Background: Chronic shoulder pain is pain that lingers more than three months continuously or intermittently associated with restricted range of movement. Shoulder pain with restriction of movements is commonly seen in inflammatory and degenerative disease of shoulder joint. Suprascapular nerve block has shown promising results in limited trials in reducing shoulder pain and improvement in range of movements. No large randomized placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain using bupivacaine/bupivicane+methyl prednisolone comparing pain and improvement in range of movement is available. Aims & objectives: To assess and compare the efficacy of Suprascapular nerve block for chronic shoulder pain using placebo (normal Saline), only Bupvicain and Bupvicain +methyl prednisolone, in terms of pain relief, duration of relief and improvement in range of movements. Methods and materials: 90 cases with chronic shoulder pain were evaluated clinically and radiologically. At random these cases were allotted three study groups. On randomized basis group of 30 cases were given 10ml of 0.5% bupivacaine, another 30 cases were given 10 ml of 0.5%bupivacaine and 40mg of methylprednisolone acetate and remaining 30 were given .9% normal saline as placebo to block the suprascapular nerve as an outpatient procedure. Cases were followed up on 2nd, 7th, 21st and 90 days for range of movements and for pain according to VAS score. Results: Evaluation of the efficacy of the block was compared by verbal pain scores and improvement of range of movement in % at 2 days, 7 days, 21days and 3 months after the injection. Maximum improvement is noted with bupivacaine+methyl for suprascapular nerve block in cases of chronic shoulder pain. Conclusion: Suprascapular nerve block is safe, effective and well tolerated treatment for patient with chronic shoulder pain. Study group with mixed drug of bupivacaine and methyl prednisolone is most effective. .
Key words: Chronic shoulder pain, Suprascapular nerve block, Bupivacaine, Methylprednisolone acetate, Placebo (normal saline). References: 1.Pope D Croft P et al. Prevalence of shoulder pain in the community: the influence of case definition. Ann Rheum Dis 1997;56:308-12. .Chakravarty KK, Webley M. Disorders of the shoulder: an often unrecognized cause of disability in elderly people. BMJ 1990;300:848–9. 3.Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic surgery: a new modality? Anesth Analg 1997;84:1306–12. 4.Gray H. Anatomy: descriptive and applied. 30th ed. London: Longmans, Green and Co, 1949:1123–4. 5.Emery P, Wedderburn L, Grahame R. Suprascapular nerve block for shoulder pain in rheumatoid arthritis. BMJ 1989;299:1079–80. 6.Brown DE, James DC, Roy S. Pain relief by suprascapular nerve block in glenohumeral arthritis. Scand J Rheumatol 1988;17:411–5. 7.Green S, Buchbinder R, Glazier R, Forbes A. Systematic review of randomized controlled trials of interventions for painful shoulder: selection criteria, outcome assessment, and efficacy. BMJ 1998;316:354–60. 8.Van der Heijden GJ, van der Windt DA, Kleijnen J, Koes BW, Bouter LM. Steroid injections for shoulder disorders: a systematic review of randomized clinical trials. Br J Gen Pract 1996;46:309–16. 9.Van der Winddt DA, van der Heijden GJ, Scholten RJ, Koes BW, Bouter LM. The efficacy of non-steroidal anti-inflammatory drugs (NSAIDS) for shoulder complaints. A systematic review. J Clin Epidemiol 1995;48:691–704. 10.Dangoisse MJ, Wilson DJ, Glynn CJ. MRI and clinical study of an easy safe technique of suprascapular nerve blockade. Acta Anaesth Belg 1994;45:49–54. 11.Gado K, Emery P. Modified suprascapular nerve block with bupivacaine alone effectively controls chronic shoulder pain in cases with rheumatoid arthritis. Ann Rheum Dis 1993;52:215–8. 12.Woolf CJ. Somatic pain pathogenesis and prevention. Br. J Anaesth 1995;75;169-76. 13.Lewis RN. The use of combined suprascapular and circumflex nerve blocks in management of chronic arthritis of the shoulder joint. Eur Acad Anaesth 1999;16;37-41. 14.Shanahan EM, Ahern M, Smith M, Wetherall M, Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003 May;62(5):400-6. 15.Lewis RN. The use of combined suprascapular and circumflex nerve blocks in management of chronic arthritis of shoulder joint. Eur Acad Anaesth 1999;16;37-41.
Copyright © 2013 Salgia Anil et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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