Posterior Versus Anterolateral Approach Interscalene Catheter Placement

Abstract

Anterolateral interscalene catheters perform more effectively and are procedurally more easily placed compared with catheters placed using the posterior approach.

Randomized Study of the Effect of Local Anesthetic Volume and Concentration on the Duration of Peripheral Nerve Blockade

“…17 Subsequently, an ultrasound-guided (SonoSite HFL/M-Turbo; SonoSite, Bothell, Washington) anterolateralapproach interscalene catheter was placed, using a previously described technique (see www.ultrasoundblock.com). 15 A 10-mL, 5% dextrose -filled syringe connected to a nerve stimulator (Pajunk Vario, Tucker, Georgia) set at 0.8 mA (0.1 ms, 2 Hz) was inserted approximately 1 cm posterior to the sternomastoid muscle dorsal border approximately 3 cm cephalad of the sixth/ seventh cervical vertebral level.…”

The Role of Continuous Peripheral Nerve Blocks

“…However, many reports confirm the feasibility of ultrasound-guided catheter-insertion with a great success rate [134, 135] also if there are few RCTs available [19, 136–138]. The description of the different techniques for ultrasound-guided catheter insertion (needle out-of-plane with nerve in short-axis approach and needle in-plane with nerve in short-axis or long-axis approaches) are well described in a recent editorial [139].…”

Catheter Orifice Configuration Influences the Effectiveness of Continuous Peripheral Nerve Blockade

“…A further 2 mL was infiltrated subcutaneously in a similar caudad direction approximately 30 degrees posterior to the initial injection and 2 mL in the triangular area in between.'' 14 Following the superficial cervical plexus block, patients were taken to the operating room and transferred to the operating table for subsequent catheter placement. A pulse oximeter was applied, and appropriate aseptic technique observed.…”

“…A 4-cm, 18-gauge insulated Tuohy needle (Contiplex Tuohy; B|Braun) attached to a 10 mL saline-filled syringe connected to a nerve stimulator (Vario; Pajunk, Tucker, Ga) set at 0.2 mA (0.1 millisecond, 2 Hz) was inserted approximately 1 cm posterior to the sternomastoid muscle dorsal border approximately 3 cm cephalad of the sixth/ seventh cervical vertebral level.'' 14 Needle advancement was with the use of out-of-plane needle-probe orientation through the subcutaneous tissues into the middle scalene muscle (always associated with a ''pop'' as the prevertebral/scalene fascia is penetrated) until tissue displacement was observed just lateral to the 2 most superficial brachial plexus elements. At the sixth/ seventh cervical vertebral level, this corresponds to the fifth/ sixth cervical roots or superior/middle trunks.…”

“…If a sustained motor response was present at less than 0.2 mA, needle manipulation occurred until the response was eliminated.'' 14 Following confirmation of correct needle tip position, with the needle bevel facing laterally, and the needle-catheter guide sited within the needle hub, a nonstimulating catheter was blindly advanced 3 to 7 cm beyond the needle tip and then, after needle withdrawal, withdrawn until 0.5, 2.5, or 5 cm of catheter remained past the original needle tip position.…”