He Amy, Handlogten Kathryn S, Kor Benjamin T, Brown Michael J, Elhassan Bassem T, Curry Timothy B, Kor Todd M, Stewart Thomas M
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
JSES Int. 2023 Dec 15;8(2):310-316. doi: 10.1016/j.jseint.2023.11.013. eCollection 2024 Mar.
Brachial plexus catheter placement at the interscalene level is beneficial for shoulder analgesia but presents logistical challenges due to the superficial nature of the plexus at this level, increased patient movement in the neck, and therefore higher likelihood for catheter dislodgement.
Patients requiring shoulder arthroscopy and suprascapular nerve decompression were identified. Under arthroscopic guidance, a catheter was placed percutaneously into the scalene medius muscle next to the suprascapular nerve and the upper trunk of the brachial plexus. Patients were followed postoperatively for perioperative analgesic outcomes.
Ten patients were identified and consented for intraoperative brachial plexus catheter placement. Patient demographics and surgical details were determined. Postoperative adjunctive pain management and pain scores were variable. Two patients required catheter replacement using ultrasound guidance in the perioperative anesthesia care unit due to poorly controlled pain. There were no incidents of catheter failure due to dislodgement.
This study presents the first description of arthroscopically-assisted brachial plexus catheter placement. This method may present an alternative to traditional ultrasound guided interscalene catheter placement. Further study is needed to determine if analgesic outcomes, block success, and dislodgement rates are improved with this method.
在肌间沟水平放置臂丛神经导管有利于肩部镇痛，但由于该水平臂丛神经位置表浅、患者颈部活动增加，因而导管移位的可能性更高，这给操作带来了后勤方面的挑战。
确定需要进行肩关节镜检查和肩胛上神经减压的患者。在关节镜引导下，经皮将导管置入肩胛上神经和臂丛神经上干旁的中斜角肌内。术后对患者的围手术期镇痛效果进行随访。
确定了10例患者并同意在术中放置臂丛神经导管。确定了患者的人口统计学资料和手术细节。术后辅助疼痛管理和疼痛评分各不相同。2例患者因疼痛控制不佳，在围手术期麻醉护理单元需要在超声引导下更换导管。没有因导管移位导致导管失效的情况。
本研究首次描述了关节镜辅助下臂丛神经导管置入术。该方法可能是传统超声引导肌间沟导管置入术的一种替代方法。需要进一步研究以确定该方法是否能改善镇痛效果、阻滞成功率和移位率。
