TITLE:
Neural Modulation of Hemiparetic Shoulder Pain by Repetitive Ultrasound-Guided Suprascapularis Nerve Block
AUTHORS:
Luigi Di Lorenzo, Santopadre Domenico
KEYWORDS:
Shoulder Pain; Nerve Block; Pre Emptive Analgesia; Neurological Rehabilitation; Stroke
JOURNAL NAME:
Open Journal of Anesthesiology,
Vol.3 No.3,
May
9,
2013
ABSTRACT: Background: Neural
blockade is widely used in clinical practice to alleviate acute or chronic
pain, including pain during rehabilitation. To
date there is little controlled evidence to confirm the efficacy of nerve
blocks in hemiparetic shoulder pain after stroke. Design: This study is a prospective,
open label, cohort trial reporting result from a cohort of stroke patients affected by
shoulder pain. Aim: As a cohort study
report, in which it is often firstly reported the possibility
of an association between an observed effect and a specific environmental based
on detailed clinical evaluations and histories, we aim to firstly provide clues
in identifying Suprascapularis Nerve blockade as further valuable approach for
shoulder pain after stroke. Population: We
studied a cohort of patients affected by hemiparetic shoulder pain after
Stroke. Methods: Our protocol foresees nerve blocks to be performed
each 3 out of 4 days (treatment lasting 30 days) in conjunction with a
rehabilitation program with the first aim to provide the window of opportunity
to proceed with effective rehabilitation. 47 potential study subjects fulfilled
the study criteria and were enrolled. Twenty-four subjects were randomised to
the study Group to receive SSNB for the pain of their hemiparetic shoulder
while 23 subjects randomized to the control
Group whose member did not receive SSNB. They received serial blocks
each 3 out of 4 days during rehabilitation.Results: Both
treatment reported a reduction in the intensity of their shoulder pain,
according to data collected from day 1 through
day 42 (6 weeks). Study Group patients, receiving SSNBs, reported significant improvement
from entry through the whole follow-up period. The efficiency data were higher
for SSNB Group after 2 weeks and again for SSNb group at the end of treatment. Conclusion: Excellent pain relief was achieved in SSNB without
clinically relevant complications, these patients
having a better improvement on pain during rehabilitation, than the control
subjects. Great efficacy has been achieved by combining a nerve block and
rehabilitation. About Clinical Rehabilitation Impact, we believe that
Suprascapularis nerve blocks can help the stroke survivors maintain an ambulatory
or outpatient treatment status, maintain participation in a physical therapy or
rehabilitation program, decrease the need for analgesics and in some cases lead to a complete pain relief.