Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: Technique, efficacy, and complications

• Published in: Journal of shoulder and elbow surgery Vol. 16; no. 4; pp. 388 - 395
• Main Authors: Bryan, Nathaniel A., MD, Swenson, Jeffrey D., MD, Greis, Patrick E., MD, Burks, Robert T., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2007; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory Surgical Procedures; Analgesics, Opioid - therapeutic use; Arthroscopy; Biological and medical sciences; Brachial Plexus; Catheterization - adverse effects; Catheterization - methods; Catheters, Indwelling - adverse effects; Female; Humans; Male; Medical sciences; Middle Aged; Nerve Block - adverse effects; Nerve Block - methods; Orthopedics; Pain, Postoperative - drug therapy; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Shoulder Joint; Human; Postoperative; Pneumothorax; Intravenous administration; Effusion; Respiratory disease; Toxicity; Catheter; Morphine; Narcotic analgesic; Pain; Treatment; Surgery; Shoulder; Pleural disease; Complication; Ambulatory; Technique; Ultrasound
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2006.10.012

Indwelling interscalene catheters are utilized for inpatient postoperative pain control after shoulder surgery. Improved medical equipment and advanced techniques may allow safe and efficacious outpatient use. One hundred and forty-four consecutive indwelling interscalene catheter placements were reviewed to determine adverse events, complications, and efficacy. Real-time ultrasound-guided catheter placement technique is described. Post-anesthesia care unit (PACU) narcotic consumption and last recorded pain score were reviewed to gauge efficacy. The catheter placement technique was 98% successful. There were 14 (9.7%) minor adverse events including inadequate analgesia (8), accidental catheter removal (4) of disconnection (1), and shortness of breath (1). The single complication (0.7%) was a small apical pneumothorax. The average PACU narcotic consumption in intravenous morphine equivalents was 1.7 mg. The average last recorded PACU pain score on a scale of 1 to 10 was 0.6. Catheter placement under real-time ultrasound guidance is accurate. Outpatient use of indwelling interscalene catheters is safe and efficacious.