Personal tools
  Members Area  

Skip to content. | Skip to navigation

Sections
You are here: Home → Events → ANZCA Annual Scientific Meetings → 2007 ASM → 300 Prospective Ultrasound (US) Assisted Interscalene Catheters for Ambulatory Shoulder Surgery
 

300 Prospective Ultrasound (US) Assisted Interscalene Catheters for Ambulatory Shoulder Surgery

Michael Fredrickson, FANZCA, The University of Auckland, NZ
Craig Ball, Adam Dalgleish

Purpose of Study

We previously reported the effectiveness of a prospective series of 60 interscalene catheters (ISC) placed with the assistance of portable ultrasound (1). We now report a total of 300 patients, looking primarily at patient perception and complications of the technique. Additionally, we assessed how useful portable US was in visualising the interscalene brachial plexus (BP).

Method

With IRB approval and informed consent, 300 consecutive patients were included. Under a combination of US guidance and neurostimulation, an ISC was inserted and managed in the home as previously described (1).

Result

45% of patients underwent rotator cuff repair. The ISC success rate in PACU was 96%, although 4.3% required withdrawal of the catheter 1 cm, and the administration of a ropivacaine bolus. 10 patients (3 %) required replacement of the ISC in PACU. In one patient, ISC insertion was unsuccessful. Individual trunks were visible in 63% of patients, the interscalene groove (IG) but not trunks in 25%, while in 11% neither the BP nor the IG could be visualised. The median patient satisfaction score was 9/10 and 96% said they would have the technique again. When questioned, the most commonly reported dislike was the weight/bulkiness of the device (9.4%). One patient required antibiotic treatment for ISC entry site infection. New neurological symptoms beyond day 21 were present in 8 patients (table 1), but in only 4 (1.3%), could they be linked with the ISC.

Conclusion

In our setting, US-guided ISC placement and ambulatory management was associated with a high success rate, patient satisfaction and a low incidence of significant complications. With the ultrasound used in this study, there is a significant subgroup of patients in whom ultrasound is of limited use in visualising the BP at the C6 level.

References (1) Fredrickson M. Free Paper. ANZCA ASM 2006

TABLE 1: New Neurological Symptoms Beyond Day 21

Patient Details Onset Resolution Probable Aetiology
1 Numbness thumb/forefinger Surgery 4 weeks ?ISC
2 Numbness/weakness thumb/forefinger Day 10 Unresolved at 6 weeks ?ISC
3 Numbness thumb Surgery 6 months ?ISC
4 Ptosis Surgery 4 weeks ISC
5 Pain in wrist and middle/ring fingers 6 weeks Unresolved at 8 weeks Carpel Tunnel Syndrome
6 Numbness/weakness ulnar distribution Surgery Almost resolved at 7 months ? Sling ? Physiotherapy
(Surgery complicated by wound infection requiring drainage/debridement)
7 Intermittent numbness ulnar distribution 4 weeks 5 months ? Sling ? Physiotherapy
(Surgery complicated by frozen shoulder)
8 Weakness in muscles supplied by suprascapular and anterior interosseus nerves 10 days Unresolved at 8 months EMG and clinical picture consistent with acute brachial neuritis. Most likely systemic process.
Document Actions