RU2362594C1 - Way of anesthesia of suprascapular nerve by anesthetic introduction in area of cutting of scapula - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: way concerns medicine, namely to traumatology and orthopedy, and can be used for elimination of a painful syndrome at patients at traumas and diseases in the field of a humeral joint. For this purpose a line of the projection of an upper edge of arista of scapula is chosen as a reference point. On this line a point located on border of its internal and average third is determined. Needle puncture is performed in the received point. The needle is pulled to the area of scapula cutting from the puncture point, thus carry out it concerning back surface of the scapula.

EFFECT: maintenance of adequate and safe anaesthesia of a suprascapular nerve at the expense of its carrying out is more distal than a cutting of a scapula away from large nervous and vascular formations.

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Description

The invention relates to medicine, namely to traumatology and orthopedics, can be used to eliminate pain in patients with injuries and diseases of the shoulder joint and its region.

For anesthesia during surgical interventions on the upper limb, high conductive anesthesia of the brachial plexus in the supraclavicular region is used to treat patients with shoulder-shoulder periarthritis with pain. In case of incomplete anesthesia of the brachial plexus, selective anesthesia of the individual nerves of this plexus is additionally performed (see D.E. Morgan, M.S. Mikhail. Clinical anesthesia. M: Publishing House BINOM, 2006). During arthroscopic surgery on the shoulder joint or during interstitial anesthesia of the brachial plexus, an suprascapular nerve is anesthetized (see D.P. Ramfell, D.M. Neil, K.M. Wiskoumi. Regional anesthesia. M .: MEDpress-inform, 2007).

One of the methods of anesthesia when repositioning a shoulder dislocation is intra-articular anesthesia. Some authors note (E.G. Gryaznukhin, I.T. Abdurakhmanov, 2005) that for these purposes, local anesthesia of the shoulder joint can be used by introducing anesthetic into the hematoma and it is advisable to anesthetize the supraspinatus, supraspinatus and subscapularis muscles to enhance local anesthesia.

The suprascapular nerve is formed from bundles of nerve fibers of the IV, V, VI cervical spinal nerves. It is separated from the upper bundle of the brachial plexus and is located at the upper edge of the plexus under the trapezius muscle and lower abdomen of the scapular-hyoid muscle. The nerve forms a bend laterally and posteriorly under the collarbone. The suprascapular nerve is directed to the scapular notch, and then passes under the superior transverse ligament and branches in the supraspinatus and infraspinatus muscles (K.A. Grigorovich, 1981; G.F. Ivanov, 1949; M.R. Sapin, 2001; R.D. Sinelnikov, Ya.R. Sinelnikov, 1996, etc.).

Next, the suprascapular nerve bends around the neck of the scapula and the base of the acromial process, passes under the inferior transverse ligament of the scapula into the infraspinatal fossa and branches out to the infraspinatus muscle and the posterior surface of the capsule of the shoulder joint.

Closest to the claimed solution is the method described in the literature for anesthesia of the suprascapular nerve by introducing an anesthetic into the scapular region of the scapula (A.Yu. Pashchuk. Regional anesthesia. M: Medicine, 1987). The method is as follows. The scapula is determined. In parallel, the line of the spinous processes in the middle between the acromial process and the inner edge of the scapula draw a vertical line. The needle injection site is located on the bisector of the upper outer quadrant at a distance of 2.5 cm from the intersection of the mentioned lines. Create a lemon peel. A thin needle with a length of about 5 cm is inserted perpendicular to the frontal plane until it contacts the scapula, preceding its advancement by introducing small portions of the anesthetic solution. Then, by moving the tip of the needle, they grope the scapula, where 3-5 ml of a 1% solution of xicaine or prilocaine or a 1.5% solution of trimecaine are introduced with an additional advance of the needle by 0.5-1 cm. The needle is even for very obese patients can not be entered deeper than 6 cm. For complete anesthesia of the shoulder joint, an additional intraarticular injection of several ml of anesthetic solution is necessary.

According to this method, anesthesia of the suprascapular nerve first occurs in the scapular region of the scapula, and then, after additional advancement of the needle by 0.5-1 cm, anesthesia occurs proximal to the upper chest.

The disadvantages of the method of anesthesia of the suprascapular nerve by introducing an anesthetic into the scapular region of the scapula with this direction of the needle is damage to the pleura with the formation of pneumothorax. This is due to the fact that the needle, after passing through the notch of the scapula, is located in the soft tissues and the end of the needle is directed directly towards the chest cavity.

The objective of the invention is to develop a less secure, more advanced and effective method of anesthesia of the suprascapular nerve.

The technical result is to increase the safety of anesthesia of the suprascapular nerve.

The technical result is achieved by the fact that during anesthesia of the suprascapular nerve by introducing an anesthetic into the scapular region of the scapula, including determining the location of the needle injection on the projection onto the skin line determined by the bone landmarks, and holding the needle into the scapular region of the scapula, in accordance with the invention as a bone of the reference point, select the upper edge of the spine of the scapula, and as the point of injection of the needle, determine the point located on the boundary of the inner and middle third of the segment formed by the projection of the upper edge of the spine of the scapula tissue, while holding the needle from the point of injection into the region of the scapula excision is carried out relative to the posterior surface of the scapula.

The method of anesthesia of the suprascapular nerve by introducing an anesthetic into the scapular region of the scapula (see drawing) is as follows. In the seated position of the patient, the spine of the scapula 1 is determined, on the skin cover a segment is made in the form of a projection of the line 2 of the upper edge of the spine of the scapula and a point 3 is located on it, located on the border of the inner and middle third of the segment formed by the projection of this line on the skin. Then hold the needle 4 in the area of the cutout 5 of the scapula relative to the rear surface of the scapula. The correct position of the needle is confirmed by the appearance of paresthesia, after which the needle is slightly pulled back to avoid intraneural injection and 10 ml of a 1.5% solution of anesthetic, such as trimecaine, are injected.

During anesthesia of the suprascapular nerve according to the claimed method, nerve anesthesia occurs distal to the scapular notch, where the nerve, passing under the upper transverse ligament of the scapula, lies close to the periosteum, and the cojus vessels are located above the ligament, so the vessels cannot be damaged by the needle. The puncture channel of the needle is directed to the scapular region of the scapula, and with further advancement of the needle, it abuts against the bone. Therefore, when performing anesthesia of the suprascapular nerve by the proposed method, it is practically impossible to damage the pleura and the occurrence of pneumothorax. Anesthesia of the suprascapular nerve is performed by introducing an anesthetic into the scapular region of the scapula aside from large nerve and vascular formations.

Clinical example 1.

Patient S-va I.M., 23 years old (Outpatient medical record No. 382), 02/11/07 was admitted to the primary care department of the trauma department No. 1 of the Central City Hospital of Cheboksary with a diagnosis of closed front dislocation of the right shoulder . After clinical and radiological examination, the patient underwent anesthesia of the suprascapular nerve with a solution of trimecaine 1.5% - 10.0 ml according to the proposed method in combination with intra-articular anesthesia with a solution of novocaine 0.5% - 40.0 ml. After 15 minutes, the anesthesia of the right shoulder joint was completely anesthetized and the dislocation of the right shoulder was reduced. After applying the plaster cast, control radiography was performed.

In anesthesia of the suprascapular nerve, the needle is held in contact with the bone. Minor paresthesia was obtained and anesthetic was then administered. There were no complications of the technique for performing anesthesia.

Clinical example 2.

Patient O-in P.S., 80 years old (Outpatient medical record No. 709), on March 11, 07, was admitted to the primary care unit of the trauma department No. 1 of the Central City Hospital of Cheboksary with a diagnosis of closed complicated axillary dislocation of the right shoulder with marginal fracture of the articular cavity of the right scapula. After clinical and radiological examination, anesthesia of the suprascapular nerve with a solution of trimecaine 1.5% - 5.0 ml was performed according to the proposed method in combination with intraarticular anesthesia with a solution of novocaine 0.5% - 40.0 ml. After 10 minutes, the anesthesia of the region of the right shoulder joint occurred and reduction of the dislocation of the right humerus was performed. After this, a plaster cast was applied and a control radiography was performed.

Clinical example 3.

Patient I-s S.A., 27 years old (Outpatient medical record No. 387), was admitted on 10.11.07 to the traumatology department of the polyclinic of the City Clinical Hospital No. 1 of Cheboksary with a diagnosis of Closed anterior dislocation of the left shoulder with detachable fracture of a large tubercle. After clinical and radiological examination, anesthesia of the suprascapular nerve with a solution of trimecaine 1.5% - 10.0 ml was carried out according to the proposed method in combination with local anesthesia of the left shoulder joint with a solution of novocaine 0.5% - 40.0 ml. After 10 minutes, the anesthesia of the left shoulder joint area was completely anesthetized, after which the dislocation of the left shoulder and plaster cast were applied.

This method of anesthesia of the suprascapular nerve by introducing an anesthetic into the scapular region of the scapula is easy to use. It can be used as an independent method of treatment, as an adjunct in cases of insufficient anesthesia for conduction anesthesia of the brachial plexus, as well as in combination with infiltration anesthesia of the shoulder joint and with intraarticular anesthesia in the treatment of both inpatient and outpatient patients.

Thus, examples of using the proposed method of anesthesia of the suprascapular nerve in the clinic by introducing anesthetic into the scapular region of the scapula show that there is complete anesthesia in the innervation zone of this nerve, technically performing anesthesia is not difficult. This method of anesthesia can be successfully applied in urgent traumatology.

The use of this method of anesthesia of the suprascapular nerve was tested in a clinic in the treatment of 24 patients with a positive result.

Claims (1)

The method of anesthesia of the suprascapular nerve by introducing an anesthetic into the scapular region of the scapula, including determining the location of the needle injection on the projection onto the skin of the line determined by the bone landmarks, and holding the needle into the scapular region of the scapula, characterized in that the upper edge of the scapula bone is chosen as the bone landmark , and as the point of injection of the needle, a point is located on the boundary of the inner and middle third of the segment formed by the projection of the upper edge of the spine of the scapula, while holding the needle from the point of injection in Part of the notch of the scapula is relative to the posterior surface of the scapula.

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