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Ultrasound-guided posterior approach for the placement of a continuous interscalene catheter.

Abstract：

BACKGROUND AND OBJECTIVES:The posterior approach to performing a continuous brachial plexus block at the level of the nerve roots has been described using traditional superficial landmarks. We describe an ultrasound-guided approach for the placement of a continuous interscalene brachial plexus catheter at the level of the nerve roots using a posterior approach. In addition, we provide the clinical characteristics of the first 16 catheters placed at our institution utilizing this approach. METHODS:Sixteen patients having major shoulder surgery underwent ultrasound-guided placement of a posterior interscalene catheter at the level of the nerve roots. After generation of an optimized short axis image of the neural and vascular structures in the midneck, a 17-gauge Tuohy needle was directed into the skin between the levator scapulae and middle scalene muscles. Using the in plane approach, the needle was advanced until the tip was located between C5 and C6 nerve roots. Following a bolus injection of local anesthetic, a catheter was threaded 2 to 4 cm and secured. Visualization of the spread of local anesthetic through the catheter was used to dynamically confirm correct perineural catheter location. The characteristics of these catheters were assessed including dislodgment, postoperative opioid consumption, complications, and patient satisfaction. RESULTS:All 16 catheters were successfully placed. There were no unintended catheter dislodgments. Patient satisfaction was high and postoperative opioid consumption was minimal. CONCLUSIONS:Results suggest the use of ultrasound for placing a continuous interscalene nerve catheter via the posterior approach is a viable technique that offers an alternative to the more conventional non-image-guided superficial landmark techniques.

journal_name

Reg Anesth Pain Med

journal_title

Regional anesthesia and pain medicine

authors

Antonakakis JG,Sites BD,Shiffrin J

doi

10.1016/AAP.0b013e3181933a53

subject

Has Abstract

pub_date

2009-01-01 00:00:00

pages

64-8

issue

1

eissn

1098-7339

issn

1532-8651

pii

00115550-200901000-00014

journal_volume

34

pub_type

杂志文章

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