Interscalene catheter

BACKGROUND: To compare the complications and efficacy of pain relief of the interscalene anesthetic block using either a single-injection (SI) vs. a continuous, indwelling catheter (CIC) for arthroscopic rotator cuff repair surgery. METHODS: Patients undergoing primary, arthroscopic rotator cuff repair without concomitant open procedure or biceps tenodesis were prospectively enrolled by 4 fellowship-trained sports medicine and shoulder surgeons. Patients received either a SI or CIC preoperatively based on surgeon preference...

BACKGROUND: Brachial plexus catheter placement at the interscalene level is beneficial for shoulder analgesia but presents logistical challenges due to the superficial nature of the plexus at this level, increased patient movement in the neck, and therefore higher likelihood for catheter dislodgement. METHODS: Patients requiring shoulder arthroscopy and suprascapular nerve decompression were identified. Under arthroscopic guidance, a catheter was placed percutaneously into the scalene medius muscle next to the suprascapular nerve and the upper trunk of the brachial plexus...

Brachial plexus blocks at the interscalene level are frequently chosen by physicians and recommended by textbooks for providing regional anesthesia and analgesia to patients scheduled for shoulder surgery. Published data concerning interscalene single-injection or continuous brachial plexus blocks report good analgesic effects. The principle of interscalene catheters is to extend analgesia beyond the duration of the local anesthetic's effect through continuous infusion, as opposed to a single injection. However, in addition to the recognized beneficial effects of interscalene blocks, whether administered as a single injection or through a catheter, there have been reports of consequences ranging from minor side effects to severe, life-threatening complications...

Reverse total shoulder arthroplasty (RTSA) is a widely employed surgical intervention for managing advanced shoulder arthritis. Postoperatively, patients frequently experience intense pain, particularly within the first 48 hours. Effective pain management through regional analgesia not only facilitates a quicker hospital discharge but also minimizes the reliance on opioids. One such regional analgesic approach is the combined suprascapular and axillary nerve block, which targets the glenohumeral joint, rotator cuff muscles, and the shoulder's lateral region for effective pain alleviation...

Postoperative pain after surgical clavicle fixation is difficult to treat and often responds incompletely to opioid analgesics. Unfavorable side effects and the risk of misuse of opioid analgesics make regional anesthetic techniques an attractive strategy for treating clavicular pain. Literature on continuous nerve blocks with catheter placement for more prolonged pain control for clavicle fractures is scarce, while such techniques are common for other shoulder surgeries. This case report presents a successful continuous interscalene brachial plexus block (ISB) after surgical fixation of a midshaft clavicle fracture...

BACKGROUND: Continuous interscalene brachial plexus block (ISB) is widely used for arthroscopic shoulder surgery, but the incidence of hemidiaphragmatic paresis (HDP) has been reported to reach 100%. Several methods, including injections distal to the C5-C6 nerve roots, have been attempted to reduce the HDP incidence. However, catheter placement distal to the C5-C6 nerve roots interferes with the surgical site. OBJECTIVE: Our primary objective was to describe a new technique, the supraclavicular brachial plexus block (SCB), using the proximal longitudinal oblique approach (PLO-SCB), which can facilitate catheter placement and, when compared with ISB, to test whether this would provide noninferior analgesia and spare the phrenic nerve...

Arthroscopic rotator cuff repair is one of the most painful surgical procedures; patients complain of pain especially during the first 48 hours postoperatively. Pain management is an essential goal to reduce the demand for analgesic agents and patient discomfort. Various methods have been introduced for arthroscopic rotator cuff repair, including continuous arthroscopy-guided suprascapular nerve blocks (SSNB) and interscalene nerve blocks. However, the aforementioned procedures have shown disadvantages such as catheter mobilization, which may cause injury to the artery, a weak analgesic effect, and Horner syndrome, as well as phrenic nerve paralysis...

Latissimus dorsi (LD) tendon rupture is a rare injury that occurs in athletes throughout a wide range of sports, including baseball, rock climbing, tennis, and golf. LD tendon repair requires analgesia in nerve distributions from C5-T6. A 33-year-old man presented for right LD tendon repair after rock climbing eight weeks prior to the operation. An interscalene nerve block catheter was placed preoperatively for postoperative pain control. After induction of general endotracheal anesthesia, a mid-axillary incision was made down to the sixth rib and the patient underwent LD tendon repair...

BACKGROUND: Single-shot suprascapular nerve block and superior trunk block have been reported to provide a noninferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block. This study hypothesized that continuous suprascapular nerve block provides noninferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery...

In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space...

BACKGROUND: Regional anesthesia has become a mainstay of analgesia following shoulder arthroscopic and reconstructive procedures. Local anesthetic can be injected in the perineural space of the brachial plexus by a single shot or continuously by an indwelling catheter. Although previous studies have compared efficacy and direct cost of single shot to catheters, few have evaluated unanticipated costs of on-going care or complications. Pulmonary complications can lead to unexpected admissions and emergency room visits...

BACKGROUND: Interscalene nerve catheters have been proven to be effective in managing pain after rotator cuff repair (RCR) surgery. Liposomal bupivacaine is a newer approved therapy for use around the interscalene brachial plexus, but its analgesic efficacy has limited supporting data in various patient populations. PURPOSE/HYPOTHESIS: The purpose of this study was to investigate the quality of recovery after arthroscopic RCR in patients who received either single-injection interscalene liposomal bupivacaine or an interscalene peripheral nerve catheter...

BACKGROUND: Appropriate postoperative pain management in shoulder surgeries is the mainstay of rehabilitation therapy and subsequent improved functional outcomes. However, adequate pain control either with opioids or interscalene brachial plexus block is often challenged by their side effects. In this context, this study compared the suprascapular nerve block (SSNB) to the newly emerging erector spinae plane block at the second thoracic vertebral level (high thoracic-ESPB) as an alternative pain therapy...

Scapulectomy is performed as a limb-sparing procedure in the management of tumours of the proximal humerus and shoulder girdle. Analgesic outcomes following this procedure are poorly documented in the literature. In our case, satisfactory analgesia following extended scapulectomy and free-flap reconstruction was achieved with a combination of multi-site continuous nerve block catheters and patient-controlled analgesia, for a patient with chronic pain who had a high pre-operative opioid requirement. Multiple continuous nerve block catheters were used, including interscalene and paravertebral catheters to provide analgesia for the shoulder resection, with a fascia iliaca compartment catheter providing analgesia to free-flap donor site on the the anterolateral thigh...

BACKGROUND: Following orthopedic surgery, patients frequently experience pain and discomfort. Multiple methods of regional anesthesia are available; however, the optimal technique to adequately manage pain while minimizing complications remains under investigation. This study aims to compare the complication rates and pain relief of single-injection, liposomal bupivacaine brachial plexus nerve block to a conventional, indwelling ropivacaine interscalene catheter (ISC) in patients undergoing arthroscopic shoulder surgery...

Revision shoulder surgery can pose significant analgesic challenges as locoregional blocks are often avoided to enable early recognition of iatrogenic nerve injuries. Our case describes the utilisation of pre-operative and intra-operative low-frequency percutaneous peripheral nerve stimulation via a 'dry' interscalene catheter, inserted pre-operatively for a patient presenting for revision total shoulder arthroplasty who was experiencing significant shoulder joint pain despite a prior total shoulder arthroplasty...

Interscalene block is applied to control acute postoperative pain after arthroscopic rotator cuff repair (ARCR), typically with single-shot interscalene block (SSIB) or continuous interscalene indwelling catheter analgesia (IICA), and dexamethasone (Dex) for extending the analgesic effect. This study investigated whether perineural Dex can extend the postoperative analgesic effect of SSIB to match that of IICA. A total of 130 patients were recruited and divided into two groups (Group D, SSIB with perineural Dex, n = 94; Group C, IICA, n = 36)...

Objective: Continuous interscalene brachial plexus block (cIBPB) is an effective perioperative analgesic therapy for shoulder arthroscopic surgery (SAS) patients. This trial aimed to compare the effect of different cIBPB infusion methods on postoperative analgesia and respiratory function in patients undergoing SAS. Methods: After SAS, 88 patients were randomly assigned to four groups. Through interscalene catheter, all the patients received an initial dose of 10 mL 0...

BACKGROUND: Multimodal pain regimens in total shoulder arthroplasty (TSA) now include regional anesthetic techniques. Historically, regional anesthesia for extended postoperative pain control in TSA was administered using a continuous interscalene catheter (CIC). Liposomal bupivacaine (LB) is used for its potential for similar pain control and fewer complications compared with indwelling catheters. We evaluated the efficacy of interscalene LB compared with a CIC in postoperative pain control for patients undergoing TSA...

Regional anesthesia is an integral component of successful orthopedic surgery. Neuraxial anesthesia is commonly used for surgical anesthesia while peripheral nerve blocks are often used for postoperative analgesia. Patient evaluation for regional anesthesia should include neurological, pulmonary, cardiovascular, and hematological assessments. Neuraxial blocks include spinal, epidural, and combined spinal epidural. Upper extremity peripheral nerve blocks include interscalene, supraclavicular, infraclavicular, and axillary...