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

John G Antonakakis, Brian D Sites, Jeffrey Shiffrin
Regional Anesthesia and Pain Medicine 2009, 34 (1): 64-8

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.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"