Evaluating the five-target, three-approach scapular block technique for scapular surgeries – A prospective case series

Scapular surgeries pose unique anesthetic challenges due to complex innervation, diverse surgical approaches, and difficult patient positioning. Traditional regional anesthesia (RA) techniques often fail to provide complete coverage, necessitating either multiple blocks or general anesthesia (GA) alone. This prospective case series describes the use of a five-target, three-approach “scapular block” administered under ultrasound guidance in five patients undergoing various scapular surgeries. This block targeted five neural structures via three separate approaches: (1) superior trunk and supraclavicular nerves, (2) suprascapular and subclavian perivascular region, and (3) dorsal rami via a T2 erector spinae plane (ESP) block. All patients received GA due to prolonged surgical time and lateral positioning. Perioperative opioid requirements, pain score using the visual analog scale (VAS), and patient comfort were documented. The block enabled a significant reduction in preoperative pain scores (VAS 7–8 to <2), eliminated the need for postoperative opioids, and maintained VAS <2 for 24 h postoperatively. Patients remained hemodynamically stable, calm, and pain-free throughout. These findings suggest that the scapular block provides effective perioperative analgesia and may serve as a valuable adjunct to GA for scapular surgeries, with potential use as a sole anesthetic in select cases. This case series supports the efficacy of the scapular block as a robust adjunct to GA in scapular surgeries. Its multi-target, ultrasound-guided approach ensures comprehensive analgesia across dermatomal, myotomal, and osteotomal components of the scapula. The block holds promise as a sole anesthetic in selected cases, warranting further large-scale validation.