In response

Abstract

We would like to thank our colleagues for their interest in our article1 and their valuable comments. Their concerns about the feasibility of dorsal scapular nerve (DSN) and long thoracic nerve (LTN) blocks of course need further discussion. The study by Hanson et al2 is the milestone for DSN and LTN ultrasonography, but it is important to note that this study was conducted in 2011 and published in 2013. They have used one of the very first devices in the field of ultrasound-guided regional anesthesia. Newer devices have taken over the field with better resolution since then and improved visibility of the above-mentioned nerves can be provided. In our practice, while performing interscalene block or anterior suprascapular nerve block for shoulder surgery,3 we often identify DSN and LTN without difficulty. Having broad experience with regional anesthesia in shoulder surgery and being familiar with the ultrasonographic anatomy of the brachial plexus above the clavicle is of utmost importance. Other than ultrasonography, nerve stimulation can be useful to verify the neural structures if the clinicians are in doubt. Nevertheless, in our case, we did not need nerve stimulation because DSN and LTN structures were distinct with their thin and elongated appearance.1

We agree that nonsteroidal anti-inflammatory drugs (NSAIDs) should be part of the analgesic regimen for musculoskeletal surgery unless contraindicated.4 Our protocol already included NSAIDs as part of multimodal analgesia for patients undergoing scapulothoracic arthrodesis.5 We used a fast-acting opioid in the postanesthetic care unit because we had already administered ibuprofen intraoperatively. Since the patient was closely monitored and was in severe pain, we didn’t expect any respiratory complications due to opioid administration.

A certain degree of excellence is required for selective brachial plexus blocks. DSN and LTN blocks should be considered as part of regional anesthesia techniques for scapular surgery.