Continuous interscalene block: the good, the bad and the refined spread

Acta Anaesthesiologica Scandinavica
V H Y Ip, B C H Tsui

Abstract

Continuous interscalene block is popular for shoulder surgery, but there are several challenges when performing this continuous block. The interscalene catheter is susceptible to incidental dislodgement and migration due to movement of the head and neck. Another important consideration is phrenic nerve involvement; the phrenic nerve is susceptible to being incidentally anaesthetised with local anaesthetic during interscalene block, owing to its close proximity to the interscalene groove. We present two cases: firstly, a case demonstrating an interscalene catheter insertion approach that provides an effective spread of local anaesthetic perineurally within the interscalene groove, with the additional benefit of preventing catheter dislodgement. Secondly, we present a case in which ultrasound-guided interscalene catheter insertion resulted in phrenic nerve palsy in an asthmatic patient, where dilution or 'wash-off' of local anaesthetic with normal saline and repositioning of the catheter under ultrasound guidance resulted in rapid recovery of respiratory function and adequate pain control.

References

Feb 18, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·T Okutomi, S Hoka
Oct 16, 1999·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·T OkutomiS Hoka

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Citations

Feb 21, 2014·Regional Anesthesia and Pain Medicine·Ban C H Tsui, Derek Dillane
Sep 16, 2015·Journal of Anesthesia·Hesham ElsharkawyRichard W Rosenquist
Nov 15, 2014·Acta Anaesthesiologica Scandinavica·C RotheK H W Lange
Jun 13, 2015·Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA·Jae-Yoon KimHwa-Yong Shin
Jul 16, 2020·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Vivian IpJeevan Nagendran
Jul 13, 2021·Indian Journal of Anaesthesia·Karthikeyan Kallidaikurchi SrinivasanConor Shortt
Jun 9, 2018·Journal of Clinical Anesthesia·Ban C H Tsui, Darcy Price

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