Patient-Controlled Interscalene Analgesia After Shoulder Surgery: Catheter Insertion by the Posterior Approach

Abstract

Insertion and maintenance of an interscalene catheter is technically challenging using lateral or anterior approaches. We report a technique to provide continuous brachial plexus blockade through a 48-h infusion of ropivacaine 0.1% (5 mL/h with a 5 mL bolus dose, 20-min lockout interval) using a catheter inserted with cannula-over-needle technique on the posterior side of the neck in 120 patients undergoing shoulder surgery. All catheters were successfully placed. There were no technical complications (impossibility to thread catheter, accidental vascular, epidural or subarachnoid location), catheter dislodgment, or analgesic solution leakage. Dysphonia, Horner's syndrome, and difficulty breathing were observed in 12 patients, four patients, and one patient, respectively. One patient complained of minor paresthesia that spontaneously resolved. Three patients complained of cervical pain. Pain scores as well as ropivacaine requirement via a patient-controlled analgesia device were low. Evaluation of acute and nonacute complications in a large-size study is needed to compare efficacy and safety of this approach with existing techniques.

Comparison of Analgesic Efficacy between Single Interscalene Block Combined with a Continuous Intra-bursal Infusion of Ropivacaine and Continuous Interscalene Block after Arthroscopic Rotator Cuff Repair

“…16% (4/25) and 12% (2/17) reported by Ilfeld et al18) and Delaunay et al,19) respectively. However, these incidences were higher than those reported by Sandefo et al20) via the posterior approach, only 0.8% (1/122). Generally, mobilization exercises of the shoulder begin from one day after surgery for rotator cuff repair.…”

Posterior Versus Anterolateral Approach Interscalene Catheter Placement

“…Some might question using a Tuohy needle given this problem and might advocate a long bevel needle to facilitate muscle penetration. 24 However, Boezaart and Franco 25 and Boezaart 26 highlighted the fact that sharp needles be avoided around the neuraxis because dural cuffs can extend along the nerve roots at this level: Tuohy needles providing some protection from penetrating these cuffs with consequent subarachnoid block, or worse, intracordal injection.…”

A clinical comparison of continuous interscalene brachial plexus block with different basal infusion rates of 0.2% ropivacaine for shoulder surgery

“…The relative importance of the local anesthetic concentration/volume versus dose has significant clinical consequences given the wide range of local anesthetic concentrations used for perineural infusion [5,14,15]. Le et al [16] reported that for CISB, a lower concentration of local anesthetic at a higher basal rate provided superior analgesia.…”