Department of Anaesthesiology and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada.
Acta Anaesthesiol Scand. 2012 Apr;56(4):526-30. doi: 10.1111/j.1399-6576.2012.02650.x. Epub 2012 Feb 16.
Continuous interscalene block is popular for shoulder surgery, but there are several challenges when performing this continuous block. The interscalene catheter is susceptible to incidental dislodgement and migration due to movement of the head and neck. Another important consideration is phrenic nerve involvement; the phrenic nerve is susceptible to being incidentally anaesthetised with local anaesthetic during interscalene block, owing to its close proximity to the interscalene groove. We present two cases: firstly, a case demonstrating an interscalene catheter insertion approach that provides an effective spread of local anaesthetic perineurally within the interscalene groove, with the additional benefit of preventing catheter dislodgement. Secondly, we present a case in which ultrasound-guided interscalene catheter insertion resulted in phrenic nerve palsy in an asthmatic patient, where dilution or 'wash-off' of local anaesthetic with normal saline and repositioning of the catheter under ultrasound guidance resulted in rapid recovery of respiratory function and adequate pain control.
连续锁骨下阻滞在肩部手术中很受欢迎，但在进行这种连续阻滞时存在几个挑战。由于头部和颈部的运动，锁骨下导管容易意外移位和迁移。另一个重要的考虑因素是膈神经的牵涉；由于膈神经靠近锁骨下沟，在锁骨下阻滞时，膈神经很容易被局部麻醉剂意外麻醉。我们提出了两个案例：首先，一个案例展示了一种锁骨下导管插入方法，该方法可有效地将局部麻醉剂在锁骨下沟内沿神经周围扩散，并且具有防止导管移位的额外好处。其次，我们提出了一个病例，在这个病例中，超声引导下的锁骨下导管插入导致哮喘患者出现膈神经麻痹，用生理盐水稀释或“冲洗”局部麻醉剂，并在超声引导下重新定位导管，导致呼吸功能迅速恢复和足够的疼痛控制。
