Epidurale Fehllage eines interskalenären Plexuskatheters

Gaus, P.; Hess, Burkhard; Tanyay, Z.; Müller-Breitenlohner, H.

doi:10.1007/s00101-011-1900-5

Cited by 8 publications

(2 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, our study was not powered to detect rare complications of interscalene blocks, such as vertebral artery or epidural placement of catheters. Although both have been described in case reports ( 12 , 13 ), they are unusual complications and our results should be interpreted in this context.…”

Section: Discussionmentioning

confidence: 46%

Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study

et al. 2015

View full text Add to dashboard Cite

Background:Continuous interscalene blocks provide excellent analgesia after shoulder surgery. Although the safety of the ultrasound-guided in-plane approach has been touted, technical and patient factors can limit this approach. We developed a caudad-to-cephalad out-of-plane approach and hypothesized that it would decrease pain ratings due to better catheter alignment with the brachial plexus compared to the in-plane technique in a randomized, controlled study.Objectives:To compare an out-of-plane interscalene catheter technique to the in-plane technique in a randomized clinical trial.Patients and Methods:Eighty-four patients undergoing open shoulder surgery were randomized to either the in-plane or out-of-plane ultrasound-guided continuous interscalene technique. The primary outcome was VAS pain rating at 24 hours. Secondary outcomes included pain ratings in the recovery room and at 48 hours, morphine consumption, the incidence of catheter dislodgments, procedure time, and block difficulty. Procedural data and all pain ratings were collected by blinded observers.Results:There were no differences in the primary outcome of median VAS pain rating at 24 hours between the out-of-plane and in-plane groups (1.50; IQR, [0 - 4.38] vs. 1.25; IQR, [0 - 3.75]; P = 0.57). There were also no differences, respectively, between out-of-plane and in-plane median PACU pain ratings (1.0; IQR, [0 - 3.5] vs. 0.25; IQR, [0 - 2.5]; P = 0.08) and median 48-hour pain ratings (1.25; IQR, [1.25 - 2.63] vs. 0.50; IQR, [0 - 1.88]; P = 0.30). There were no differences in any other secondary endpoint.Conclusions:Our out-of-plane technique did not provide superior analgesia to the in-plane technique. It did not increase the number of complications. Our technique is an acceptable alternative in situations where the in-plane technique is difficult to perform.

show abstract

Section: Discussionmentioning

confidence: 46%

Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Catheter techniques for continuous postoperative analgesia are even more challenging. Despite uneventful initial LA injection before catheter placement, life-threatening and fatal complications have been reported following intrathecal [2,19,20], epidural [21], or intravascular [22,23] catheter positioning. Symptom onset for misplaced catheters can occur immediately after injection but also with a delay in non-monitored patients [24].…”

Section: Introductionmentioning

confidence: 99%

Continuous Interscalene Brachial Plexus Blocks: An Anatomical Challenge between Scylla and Charybdis?

Litz,

Feigl,

Radny

et al. 2024

Medicina

View full text Add to dashboard Cite

Brachial plexus blocks at the interscalene level are frequently chosen by physicians and recommended by textbooks for providing regional anesthesia and analgesia to patients scheduled for shoulder surgery. Published data concerning interscalene single-injection or continuous brachial plexus blocks report good analgesic effects. The principle of interscalene catheters is to extend analgesia beyond the duration of the local anesthetic’s effect through continuous infusion, as opposed to a single injection. However, in addition to the recognized beneficial effects of interscalene blocks, whether administered as a single injection or through a catheter, there have been reports of consequences ranging from minor side effects to severe, life-threatening complications. Both can be simply explained by direct mispuncture, as well as undesired local anesthetic spread or misplaced catheters. In particular, catheters pose a high risk when advanced or placed uncontrollably, a fact confirmed by reports of fatal outcomes. Secondary catheter dislocations explain side effects or loss of effectiveness that may occur hours or days after the initial correct function has been observed. From an anatomical and physiological perspective, this appears logical: the catheter tip must be placed near the plexus in an anatomically tight and confined space. Thus, the catheter’s position may be altered with the movement of the neck or shoulder, e.g., during physiotherapy. The safe use of interscalene catheters is therefore a balance between high analgesia quality and the control of side effects and complications, much like the passage between Scylla and Charybdis. We are convinced that the anatomical basis crucial for the brachial plexus block procedure at the interscalene level is not sufficiently depicted in the common regional anesthesia literature or textbooks. We would like to provide a comprehensive anatomical survey of the lateral neck, with special attention paid to the safe placement of interscalene catheters.

show abstract

Arthroscopic shoulder surgery under general anesthesia with brachial plexus block

et al. 2013

View full text Add to dashboard Cite

show abstract

Epidurale Fehllage eines interskalenären Plexuskatheters

Cited by 8 publications

References 19 publications

Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study

Ultrasound-Guided Out-of-Plane vs. In-Plane Interscalene Catheters: A Randomized, Prospective Study

Continuous Interscalene Brachial Plexus Blocks: An Anatomical Challenge between Scylla and Charybdis?

Arthroscopic shoulder surgery under general anesthesia with brachial plexus block

Contact Info

Product

Resources

About