Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and
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ORIGINAL ARTICLE
Suprascapular nerve block in hemiplegic shoulder pain: comparison of the effectiveness of placebo, local anesthetic, and corticosteroid injections—a randomized controlled study Rana Terlemez 1 & Selda Çiftçi 1 & Mahir Topaloglu 2 & Beril Dogu 1 & Figen Yilmaz 1 & Banu Kuran 1 Received: 28 December 2019 / Accepted: 20 March 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Background Shoulder pain is a common complication of hemiplegic patients that can interrupt their rehabilitation program and is associated with poorer outcomes. The usefulness of the suprascapular nerve block. (SSNB) in the stroke population has been suggested, but some concerns still remain. Objectives To investigate the effect of SSNB on pain intensity and passive range ofmotion (PROM) in patients with hemiplegic shoulder pain (HSP).Study Design: A prospective, double blind, randomized controlled trial was conductedin 34 stroke patients with HSP. They were randomly divided into three groups: Localanesthetic (LA) injection into the trapezius muscle (placebo group), LA injection into thesuprascapular notch, and LA and corticosteroid (CS) injections into the suprascapularnotch.The main outcome was visual analog scale (VAS) scores evaluated before andafter administration of the injection at 1 hour, 1 week, and 1 month. Results There were significant decreases in the VAS scores with all three injections at all follow-up time points (p: 0.001 for the placebo group, p 3 (0–10 scale) were enrolled. The exclusion criteria were aphasia, cognitive impairment (Mini-Mental State Examination score < 24), botulinum toxin treatment within the last 6 months, fixed contractures, bony deformities, uncontrolled diabetes mellitus, coagulopathy, and hypersensitivity to injection agents. All patients selected from hospitalized patients. A physiatrist, who was blinded to the group allocation, performed the baseline and control assessments. Demographic features, medical history, duration, and etiology of stroke were obtained. VAS scores were used to assess pain intensity. In the physical examination, passive range of motion (PROM) of the shoulder, Brunnstrom stage of the upper extremity and spasticity according to the modified Ashworth
The primary outcome was pain intensity assessed by the VAS score (0–10 scale). The average of VAS scores during maximum PROM (flexion, abduction, and external rotation) were calculated. For all participants, pain was assessed at baseline, and at 1 h, 1 week, and 1 month following the injection procedure. The pain intensity score, where patients rate their current pain intensity from 0 (“no pain”) to 10 (“worst possible pain”) was assessed by the same blinded physiatrist who performed all the clinical assessments. The PROM of the affected shoulder (flexion, abduction, external rotation) was evaluated at baseline and 1 h after the injection.
Methods Study design
Statistical analysis The SPSS Windows 15.0 software bundle was used to analyze the data. Data are presented as mean ± SD, numbers, and percentage.
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