Dorsal scapular nerve injury: A complication of ultrasound-guided interscalene block

摘要

Editor—In-plane ultrasound guidance is often used for inter-scalene block. This approach shifts the traditional needle insertion point of the Winnie's approach, that is, in the groove between the anterior and the middle scalene muscles,1 to a more distal (either medial or lateral and caudal) puncture site.2 The increased risk of both vascular and phrenic nerve lesions, carried by the medial to lateral approach,3 often makes anaesthetists to choose a lateral to medial needle direction to reach the brachial plexus in the interscalene groove through the middle scalene muscle. However, this approach increases the theoretical risk of damage to other branches of brachial plexus, namely the long thoracic and the dorsal scapular nerves (DSN), which run inside or in close proximity to the middle scalene muscle.4