Comment on Ozler et al.: “Interscalene Block Versus Posterior Suprascapular Block for Postoperative Analgesia in Arthroscopic Shoulder Surgery”

Dear Editor,

We read with interest the research article comparing the interscalene block (ISB) with the posterior-approach suprascapular nerve block (SSNB), both performed under ultrasound guidance.^[1] We appreciate the work of Ozler et al. ^[1] and would like to discuss a few important concepts.

First, Ozler et al. ^[1] state that studies comparing these two techniques under ultrasound guidance are limited. While we agree with this statement, the rationale behind this requires careful consideration. The posterior SSNB has the major drawback of providing incomplete sensory coverage compared with the anterior approach because it is performed distally and therefore spares branches that have already arisen. Other disadvantages are that it requires a position other than supine and is technically more difficult.^[2] Notably, it may also require additional confirmation with neurostimulation. Because of these limitations, the anterior approach, described in 2012, has gained popularity and has become the preferred technique, with many studies confirming its efficacy.^[3] Indeed, anterior SSNB produced better analgesia than posterior SSNB while providing analgesia comparable to that of ISB.^[4] Although posterior SSNB resulted in less diaphragmatic paresis than the anterior approach, this benefit comes at the expense of analgesic quality.^[4] Moreover, the clinical implications of diaphragmatic paresis are negligible.^[3] Hence, it is unsurprising that studies on posterior SSNB are limited. Indeed, it is currently reserved as a “surgeon-placed” technique (arthroscopic SSNB) when ultrasound is unavailable or expertise is lacking, when the patient refuses a regional technique while awake or sedated, or according to surgeon preference.

Second, Ozler et al. ^[1] further state that their study was the only one to assess the duration of analgesia in this comparison. Although this is technically correct, we would like to point out a study that included a third arm (anterior SSNB).^[4] We would also like to highlight several studies that compared these two techniques using a combination of posterior SSNB and axillary nerve blocks (“shoulder blocks”).^[5] Indeed, this combination has more advantages than SSNB alone.^[5]

Third, we would like to point out an error in the “References” section. References 17 and 26 are identical. We are uncertain whether this caused discrepancies in the main text.

In conclusion, posterior SSNB is inadvisable because of its many disadvantages. In contrast, anterior SSNB has become a well-established technique and is considered a better alternative to ISB. Its combination with an anterior-approach axillary nerve block (“subscapularis plane block”) requires further research.^[2,3]

Conflict of Interest

The authors declare that there is no conflict of interest.

Financial Disclosure

This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Use of AI for Writing Assistance

No AI-assisted technologies (such as Large Language Models, chatbots, or image generators) were used in the preparation of this manuscript.

Authorship Contributions

Concept – R.M.S., G.R.; Literature search – R.M.S.; Writing – R.M.S., G.R.; Critical review – R.M.S.