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The PainExam podcast

A podcast featuring's creator David Rosenblum, MD, discussing Pain Management Board Preparation, keywords, and current topics relevant to any physician who practices pain management. David Rosenblum, MD has been preparing physicians for the pain boards since 2008, and is currently the director of Pain Management at Maimonides Medical Center, AABP Pain Management , and CEO of

Feb 10, 2015

A review of the suprascapular, intercostal and paravertebral nerve blocks. 

A preview of Dr. Rosenblum's course on the ultrasoung guided suprascapular, intercostal and paravertebral nerve blocks at the 2015 AIUM conference in Orlando.



“Combination of physical treatment with Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in frozen and arthritis.”


  Abdelshafi ME, Yosry M, Elmulla AF, Al-Shahawy EA, Adou Aly M, Eliewa EA. Relief of chronic shoulder pain: a comparative study of three approaches. Middle East J Anesthesiol. 2011 Feb;21(1):83-92


—“Suprascapular nerve block can be considered the preferred treatment for non-specific shoulder pain because of being as effective as steroid injection with rare side effects.


  Taskaynatan MA, Yilmaz B, Ozgul A, Yazicioglu K, Kalyon TA. Suprascapular nerve block versus steroid injection for non-specific shoulder pain. Tohoku J Exp Med. 2005 Jan; 205(1):19-25.

—“Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in degenerative disease and/or arthritis. It improves pain, disability, and range of movement at the shoulder compared with placebo. It is a useful adjunct treatment for the practicing clinician to assist in the management of a difficult and common clinical problem.”


  Shanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis. 2003 May;62(5):400


—“Ultrasound assisted approach is a simple, reproducible technique in most patients with an easy to understand ultrasound anatomy. Adequate analgesia could be provided through a single puncture and may be an alternative to neuroaxial blocks.”


 Dieguez Garcia P, et al. Ultrasound-assisted approach to blocking the intercostal nerves in the mid-axillary line for non-reconstructive breast and axilla surgery. [Article in spanish]. Rev Esp Anestesiol Reanim 2013 Aug-Sep;60(7):365-70.



—In Percutaneous nephrolithotomy (PCNL) with nephrostomy tube placement US-guided intercostal nerve block (ICNB) performed at the 11th and 12th intercostal spaces provided effective analgesia.

  Ozkan D, et al. Effect of ultrasound-guided intercostal nerve block on postoperative pain after percutaneous nephrolithotomy : Prospective randomized controlled study. Anaesthetist 2013 Nov 1 [Epub anead of print]


—“Utilization of continous intercostal nerve block (CINB) significantly improves pulmonary function, pain control, and shortens length of stay (LOS) in patients with rib fractures.”

  Truitt MS, et al. Continuous intercostal nerve blockade for rib fractures: ready for primetime? J Trauma 2011 Dec;71(6):1548-52.


—“Concurrent combination therapy with proper medications and appropriate intercostal nerve blocks could offer satisfactory pain relief in the majority of elderly patients with Post Herpetic Neuragia (PHN).”

  Chau SW, et al. Clinical experience of pain treatment for postherpetic neuralgia in elderly patients. Acta Anesthesiol Taiwan. 2007 Jun;45(2):95-101



—“Ultrasound guided multilevel paravertebral block (PVB) with total intravenous anesthesia provides reliable anesthesia, improves postoperative analgesia.”


  Abdallah FW, et al. Ultrasound-guided Multilevel Paravertebral blocks and Total Intravenous Anesthesia Improve the Quality of Recovery after Ambulatory Breast Tumor Resection. Anesthesiology. 2013 Sep 26.


—“A transverse in-line ultrasound-guided technique improves the feasibility of placing paravertebral nerve block (PVNB) catheters using in a wide range of pediatric patients.”


  Boretsky K, et al. Ultrasound-guided approach to the paravertebral space for catheter insertion in infants and chuildren. Paediatr Anaesth. 2013 Jul 27


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