Feasibility of ultrasound-guided posterior approach for interscalene catheter placement during arthroscopic shoulder surgery

Feasibility of ultrasound-guided posterior approach for interscalene catheter placement during arthroscopic shoulder surgery

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BackgroundContinuous interscalene block has been known to improve postoperative analgesia after arthroscopic shoulder surgery.This was a prospective study investigating the ultrasound-guided posterior approach for placement of an interscalene catheter, clinical efficacy and complications after placement of the catheter.MethodsForty-two patients undergoing elective arthroscopic shoulder surgery were included in this study and an interscalene Espresso Machine (Semi/Prosumer) catheter was inserted under the guidance of ultrasound with posterior approach.

With the inplane approach, the 17 G Tuohy needle was advanced until the tip was placed between the C5 and C6 nerve roots.After a bolus injection of 20 ml of 0.2% ropivacaine, a catheter was threaded and secured.

A continuous infusion of ropivacaine 0.2% 4 ml/hr with patient-controlled 5 ml boluses every hour was used over 2 days.Difficulties in placement of the catheter, clinical efficacy of analgesia and complications were recorded.

All patients were monitored for 48 hours and examined by the surgeon for complications within 2 weeks of hospital discharge.ResultsEasy placement of the catheter was achieved in 100% of the patients and the success rate of catheter placement during the 48 hr period was 92.9%.

Postoperative analgesia was effective in 88.1% of the patients in the post anesthetic care unit.The major complications included nausea (7.

1%), vomiting (4.8%), dyspnea (4.8%) and unintended vascular punctures (2.

4%).Other complications such as neurologic deficits and local infection Hoodie around the puncture site did not occur.ConclusionsThe ultrasound-guided interscalene block with a posterior approach is associated with a success high rate in placement of the interscalene catheter and a low rate of complications.

However, the small sample size limits us to draw definite conclusions.Therefore, a well-designed randomized controlled trial is required to confirm our preliminary study.