Potential contamination of the surgical site caused by leakage from an interscalene catheter with the patient in a seated position: a case report

Abstract

Continuous catheterized nerve blockade has been used for many years to provide effective analgesia postoperatively. We report a potential complication of interscalene nerve block performed with the traditional catheter-through-needle insertion technique. Specifically, leakage from the catheter insertion site posed a risk of contamination to the sterile surgical field. We also describe an alternative catheter design to overcome this leakage problem. We present a case of leakage from the catheter insertion site during the course of an interscalene nerve block with the patient in a beach chair position for shoulder arthroplasty. Using the traditional catheter-through-needle technique, an 18G 100-mm Tuohy needle was inserted between the C6 and C7 roots under ultrasound guidance. After confirming the needle tip position, 20mL of local anesthetic (1% ropivacaine and 0.25% bupivacaine 1:1) were injected. A 20G catheter was then threaded through the Tuohy needle and carefully secured with tape and dressing. In the operating room, leakage from the catheter insertion site started to disturb the adhesives of the surgical drapes and threatened the sterility of the surgical field. The catheter was removed prior to surgery upon the surgeon's request. Upon completion of the operation, a catheter was reinserted using an alternative catheter-over-needle method. Postoperatively, no leakage was seen at or around the catheter entry site. This case report serves as a reminder that leakage from the catheter entry site remains a troublesome and hazardous issue during continuous peripheral nerve block. Leakage from the catheter insertion site often occurs due to the loose fit of the catheter in the larger diameter hole left by the Tuohy needle. We have also shown the successful use of an alternative catheter-over-needle design to minimize the risk of leakage from the catheter entry site. This technique resulted in being particularly vital for shoulder surgery with the patient in the beach chair position.