Subomohyoid–Suprascapular versus Interscalene Block: Comment

While we welcome research into regional anesthesia in order to improve the quality of our medical provision, the study by Abdallah et al. demonstrates highly relevant problems in research in this area.¹  First, the authors describe the interscalene block as one that poses dangers to certain populations. This may be true for a minority of patients such as those with severe respiratory impairment, but the vast majority of patients are not restricted by any ensuing respiratory compromise. Studies of healthy patients demonstrate that the phrenic nerve palsy is of no clinical relevance.²  Given that 2.5 yr in three hospitals were required to obtain the 136 patients in this study, there does not appear to be a large group of patients likely to benefit from a new block.

It has to be realized that regional anesthesia provision remains far from universal. Although the interscalene technique has been around for many years and refined with the use of ultrasound, a recent Canadian study demonstrated that only around half of shoulder surgery patients were receiving a nerve block for ambulatory surgery.³  This is likely much lower in many other health systems. One of the reasons for this is likely a lack of training and confidence of anesthesia providers in performing the block; lack of resources also contributes. Refining blocks further, and in effect making them more difficult, is unlikely to benefit the population as a whole. It needs to become a more significant priority in the provision of regional anesthesia that basic blocks are able to be performed competently by more anesthesiologists rather than the ever increasing number of new blocks with small, unclear benefits.

Support was provided solely from institutional and/or departmental sources.

The authors declare no competing interests.