Perineural entrapment of an interscalene stimulating catheter

Sanjib Adhikary, K. Armstrong, K. J. Chin

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

A patient undergoing elective total shoulder arthroplasty had an Arrow Stimucath™ (Arrow International Reading, PA, USA) stimulating catheter inserted in the region of the interscalene brachial plexus using an ultrasound-guided in-plane approach. There was subsequent difficulty in removing the catheter and traction was associated with painful paraesthesia in the patient's thumb. Plain X-ray revealed a hook-shaped deformity of the tip and surgical exploration was required to remove the catheter, the tip of which appeared to be trapped within the sheath of the brachial plexus. We speculate that the mechanism for entrapment in this case was deformation of the catheter tip into a hook-like shape. The subsequent catheter-neural interaction prevented asymptomatic removal. We recommend that removal of peripheral nerve catheters be attempted only after resolution of sensory block so as to enable patients to report pain or paraesthesia. Imaging with ultrasound or X-rays may help ascertain catheter tip location and confirm whether deformity is present. We also recommend a low threshold for proceeding to surgical extraction, particularly if neurological symptoms are present.

Original languageEnglish (US)
Pages (from-to)527-530
Number of pages4
JournalAnaesthesia and Intensive Care
Volume40
Issue number3
StatePublished - May 1 2012

Fingerprint

Catheters
Brachial Plexus
Paresthesia
X-Rays
Thumb
Traction
Peripheral Nerves
Arthroplasty
Reading
Ultrasonography
Pain

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

Cite this

Adhikary, Sanjib ; Armstrong, K. ; Chin, K. J. / Perineural entrapment of an interscalene stimulating catheter. In: Anaesthesia and Intensive Care. 2012 ; Vol. 40, No. 3. pp. 527-530.
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Perineural entrapment of an interscalene stimulating catheter. / Adhikary, Sanjib; Armstrong, K.; Chin, K. J.

In: Anaesthesia and Intensive Care, Vol. 40, No. 3, 01.05.2012, p. 527-530.

Research output: Contribution to journalArticle

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