Adverse events associated with continuous interscalene block administered using the catheter-over-needle method: a retrospective analysis

Abstract

BackgroundContinuous interscalene block is widely used for pain management in shoulder surgery. However, continuous interscalene block performed using the catheter-through-needle method is reportedly associated with adverse events such as pericatheter leakage of the local anesthetic, phrenic nerve paralysis, and hoarseness. Because we expected that the catheter-over-needle method would reduce these adverse events, we examined cases in which continuous interscalene block was performed using the catheter-over-needle method to determine what adverse events occurred and when.MethodsWe retrospectively reviewed the anesthesia and medical records of adult patients who underwent catheter insertion to receive a continuous interscalene block performed using the catheter-over-needle method at our hospital from July 2015 to July 2017.ResultsDuring the surveillance period, 122 adult patients underwent catheter insertion to receive a continuous interscalene block administered using the catheter-over-needle method. No case of pericatheter local anesthetic leakage was observed. Adverse events, such as dyspnea, hoarseness, insufficient anesthetic effect, dizziness, cough reflex during drinking, or ptosis, were observed in 42 patients (34.4%; 95% confidence interval 26–42.7). Most of the adverse events occurred on postoperative day 2. The median time between surgery and the onset of adverse events was 28.5 h.ConclusionsThe catheter-over-needle method may prevent the pericatheter leakage of the local anesthetic. However, adverse events occurred in more than one-third of the patients. During continuous interscalene block, patients must be carefully observed for adverse events, especially on postoperative day 2.Trial registrationThis study was registered at the UMIN Clinical Trials Registry on August 13th, 2019 (UMIN000037673).

Distance of catheter tip dislocation in continuous interscalene brachial plexus block

“…Despite proper catheterization, cases of cISBPB with inadequate postoperative analgesia in the brachial plexus innervation area are occasionally encountered. Several studies have been conducted in an effort to reduce inadequate analgesia, such as the comparison of catheter insertion approaches [ 1 - 3 ]; however, there is no consensus on the best approach. Inadequate analgesia may be associated with postoperative catheter tip dislocation from the interscalene groove, which occurs during and after surgery.…”