To the Editor:
Hussein et al.1 make a strong case for the utility of the suprascapular nerve block for analgesia after shoulder surgery, and the substitution of this block for those who cannot undergo an interscalene block. However, it should be noted that, in all of the studies the authors reviewed, these blocks were placed for analgesia, to supplement general anesthesia, rather than for surgical blockade. This is an important distinction, because many practitioners utilize the interscalene block as a primary anesthetic, in combination with propofol for sedation. Given its limited area of innervation, a suprascapular block alone cannot be used in this fashion, and even the addition of a peripheral axillary nerve block does not provide complete anesthesia for the shoulder capsule and skin overlying the area of the incisions for open or arthroscopic shoulder surgery. In considering the differences between a suprascapular and interscalene nerve block, there are a number of advantages to the use of deep sedation, typically with propofol, with the more comprehensive interscalene block, versus that of general anesthesia with a more limited block. These advantages include reduced incidence of postoperative nausea and vomiting2–5 ; earlier return of eating, drinking, and ambulation2 ; significantly shorter discharge times2,3,5 ; higher likelihood of bypassing the postanesthesia care unit3,4 ; and a lower incidence of unexpected admissions for ambulatory procedures.3,4
The authors declare no competing interests.