Perineural entrapment of an interscalene stimulating catheter

Anaesthesia and Intensive Care
S D AdhikaryK J Chin

Abstract

A patient undergoing elective total shoulder arthroplasty had an Arrow Stimucath™ (Arrow International Reading, PA, USA) stimulating catheter inserted in the region of the interscalene brachial plexus using an ultrasound-guided in-plane approach. There was subsequent difficulty in removing the catheter and traction was associated with painful paraesthesia in the patient's thumb. Plain X-ray revealed a hook-shaped deformity of the tip and surgical exploration was required to remove the catheter, the tip of which appeared to be trapped within the sheath of the brachial plexus. We speculate that the mechanism for entrapment in this case was deformation of the catheter tip into a hook-like shape. The subsequent catheter-neural interaction prevented asymptomatic removal. We recommend that removal of peripheral nerve catheters be attempted only after resolution of sensory block so as to enable patients to report pain or paraesthesia. Imaging with ultrasound or X-rays may help ascertain catheter tip location and confirm whether deformity is present. We also recommend a low threshold for proceeding to surgical extraction, particularly if neurological symptoms are present.

References

Oct 28, 2005·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Quang Dieu De TranJuan Carlos de la Cuadra-Fontaine
Sep 22, 2006·Acta Anaesthesiologica Scandinavica·C C BuckenmaierW S Flournoy
Mar 14, 2007·Regional Anesthesia and Pain Medicine·Abram H Burgher, James R Hebl
Jan 8, 2010·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Guillaume BrenierRégis Fuzier
Oct 6, 2010·International Journal of Shoulder Surgery·André P Boezaart, Patrick Tighe
Nov 10, 2010·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Steven R ClendenenSorin J Brull
Mar 2, 2011·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·Reynold DuclasSteven R Clendenen
Jun 28, 2011·Pain Medicine : the Official Journal of the American Academy of Pain Medicine·Clifford BowensRandall J Malchow
Aug 23, 2011·Regional Anesthesia and Pain Medicine·Matthew S AbrahamsJean-Louis Horn

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Citations

Oct 24, 2014·Regional Anesthesia and Pain Medicine·Brendan CarvalhoJean-Louis Horn
Nov 10, 2017·The Cochrane Database of Systematic Reviews·Carolyne PehoraBradley Johnston
Oct 8, 2019·Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews·Samer S HasanThomas R Elsass

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