217: Beyond the Limits: Bilateral SSNB for Chronic Shoulder Pain in a Renal-Compromised Triathlete

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic postsurgical pain, Pharmacological treatments, Pain in Special Populations , Treatment/management

Background and Aims: Chronic shoulder pain in aging athletes with Chronic Kidney Disease (CKD) creates a complex therapeutic dilemma. Nephrotoxic NSAIDs are strictly avoided, and standard opioids, such as morphine, carry high risks of neurotoxic metabolite accumulation. While pharmacokinetically safer options like fentanyl exist, their utility is often limited by patient refusal, as seen in this case. To bridge this void, we utilized ultrasound-guided Suprascapular Nerve Block (SSNB) with corticosteroid augmentation. We aim to demonstrate that this targeted, organ-sparing intervention bypasses systemic limitations, ensuring targeted relief and restoring high-performance function without compromising renal integrity.

Methods: A 63-year-old retired triathlete with Stage 3b CKD, diabetes, and adhesive capsulitis (VAS 8/10) presented with contraindicated NSAIDs, a morphine allergy, and refusal of fentanyl. To circumvent nephrotoxic risks and opioid limitations, we employed a kidney-safe interventional strategy. The patient underwent ultrasound-guided bilateral Suprascapular Nerve Blocks (SSNB) utilizing a mixture of 0.5% bupivacaine and methylprednisolone. This was supplemented by a left intra-articular corticosteroid injection for maximal anti-inflammatory effect. Post-procedural pain management involved a multimodal regimen of paracetamol and renally-dosed tramadol and gabapentinoids, strictly adhering to renal safety protocols to facilitate immediate rehabilitation.

Results: Combined bilateral suprascapular nerve block (SSNB) and intra-articular steroid injection yielded a significant reduction in Visual Analog Scale (VAS) pain scores, which improved from 8/10 at baseline to 1/10 at the two-month follow-up. This analgesia catalyzed immediate, aggressive rehabilitation, restoring full shoulder range of motion and enabling a successful return to swimming and cycling. These functional outcomes align with emerging data suggesting 63% of older athletes can regain pre-injury fitness post-intervention. Crucially, the intervention was devoid of adverse events. By strictly avoiding nephrotoxic NSAIDs, this strategy successfully preserved renal integrity while delivering high-performance recovery in a complex, comorbid patient.

Conclusions: Ultrasound-guided Suprascapular Nerve Block (SSNB) represents a critical, organ-sparing strategy for managing shoulder pain in Chronic Kidney Disease (CKD). By substituting nephrotoxic NSAIDs and systemic opioids with precise neuromodulation, SSNB provides potent analgesia without renal compromise. This case validates a shift toward interventional paradigms: leveraging minimally invasive precision to bypass complex medical contraindications. As a proactive clinical standard, SSNB offers a promising pathway for functional restoration in high-risk patients. It demonstrates that opioid-sparing, targeted interventions can successfully bridge the gap between intractable pain and safe rehabilitation, ensuring that comorbidities do not preclude effective pain management.

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Presenting Author: Jo Mari Darvin C. Adorador, MD, DPBA
Submitting Author: Jo Mari Darvin Adorador

Senior Author: Salvador E. Brodit Jr., MD, DPBPM

IASP 2026 Global Year theme of Neuropathic Pain: Yes