Shearing of a Continuous Interscalene Catheter with Lancinating Symptoms After an Interscalene Block: A Case Report.

Abstract

Placement of a continuous indwelling nerve block catheter is generally safe and effective for pain control in the outpatient setting1. As reported in several large series in the literature, catheter-related complications are rare1-3; however, neurologic injury is possible. We present a patient who experienced a unique complication after placement of an interscalene nerve catheter and successful postoperative anesthesia. The patient was informed that data concerning the case would be submitted for publication, and she provided consent. A healthy fifty-seven-year-old right-hand dominant woman (considered class-2 status by the American Society of Anesthesiologists) presented to our orthopaedic clinic with right shoulder pain. Five years previously, she had fallen from a standing height and had sustained a fracture of the proximal third of the humeral shaft, which had developed into a chronic atrophic nonunion with gross motion at the fracture site. She also had experienced weakness in the radial nerve distribution, suggesting partial nerve injury from the fracture. An interscalene approach to the brachial plexus was used for catheter placement to deliver continuous interscalene analgesia. This catheter was utilized to provide a longer duration of postoperative pain control than a single-shot interscalene block. An 18-gauge 50-mm Tuohy needle was advanced with use of nerve stimulator localization. Stimulation of the nerve was begun at 1.5 mA, and the stimulation progressed until the biceps contraction disappeared at 0.5 mA in order to accurately place the needle in close proximity to the nerves of the brachial plexus. A 19-gauge StimuCath (Arrow International, Reading, Pennsylvania) catheter (Fig. 1) was advanced 3 cm beyond the tip of the needle, and aspiration was negative for blood. There was no evidence of damage to the catheter before placement. A 40-mL combination bolus solution (30 mL of bupivacaine 0.5% with epinephrine, and 10 mL of …