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Subcutaneous tunneling of the interscalene catheter

Zurich, Switzerland

To the Editor:

Patient-controlled interscalene analgesia (PCIA) by means of an interscalene catheter offers excellent pain relief after major shoulder surgery¹ but, with time catheter dislocation occurs. Boezaart et al.² described a technique to fix the interscalene catheter by making a subcutaneous tunnel with the aid of a 17 G Tuohy needle. We also perform subcutaneous tunneling for the interscalene catheter. After skin infiltration with 3–4 ml lidocaine 1%, an 18 G iv cannula is inserted subcutaneously just above the suprasternal notch and then advanced cranially at an angle of 45 to exit 3–4 mm above the primary catheter insertion point. The proximal end of the catheter is threaded retrogradely through the iv cannula, before the latter is removed, so that the catheter finally is tunneled 4–5 cm subcutaneously. The catheter is fixed with usual dressing tapes.

Using this method described in 100 patients, the catheter was used for three days in 80% of the patients, for two days in 10% and in the remaining 10% for four days. The subcutaneous catheter tunnel was well accepted by all patients. Our findings support Boezaart et al.² We agree with their method of securing the catheter subcutaneously, but we recommend not to use a large and inflexible 17 G Tuohy needle for this purpose, but rather a thinner and more flexible 18 G iv cannula, which may reduce potential bleeding or damage to the small sensory cutaneous nerves while providing a very low incidence of catheter dislocation.

References

1 Borgeat A, Schäppi B, Biasca N, Gerber C. Patient-controlled analgesia after major shoulder surgery: patient-controlled interscalene analgesia versus patient-controlled analgesia. Anesthesiology 1997; 87: 1343–7.[Medline]

2 Boezaart AP, de Beer JF, du Toit C, van Rooyen K. A new technique of continuous interscalene nerve block. Can J Anesth 1999; 46: 275–81.[Abstract/Free Full Text]

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