Introduction

• Peripheral nerve catheters are a safe and

effective way of providing continuous, targeted

anesthesia

• Can serve as adjunct to multimodal analgesic

regimen in the chronic pain patient

• Case: patient with exceptionally high opioid

requirements who underwent interscalene

catheter placement

Materials and Methods

• A literature review was performed investigating

peripheral nerve catheters as adjuncts to the

analgesic regimen in chronic pain patients

• Patient gave verbal consent to write this case report

• This case report does not contain any patient

identifiable information; therefore, it is exempt from

IRB review as per Colorado Multiple Institutional

Review Board (COMIRB) policy

Case Report

• 47 year-old male with rectosigmoid adenocarcinoma with

metastases to bone presented with left humerus pathologic

fracture

• Prior to admission: methadone 15mg q8hr, ketamine 75mg

q8hr, hydromorphone PRN

• Inpatient: hydromorphone PCA 0/6/10 with a 9mg bolus q1hr

PRN

• MME= 1,556 milligram per day

• Hospital Day 3: APS consulted, left interscalene catheter

placed: 0.2% Ropivacaine at 10mL/hr with a 20mL bolus q4hr

• Post catheter placement: lower subjective pain scores (7/10

vs. 10/10), better sleep, and improved satisfaction

• Daily MMEs did not change

• Hospital Day 9: L TSA and humerus resection

• POD 1: Catheter dislodged and replaced

• POD 5: erythema at insertion site, catheter removed

• POD 9: discharged on methadone 15mg q8hr, oxycodone

40mg q2hr, naproxen, acetaminophen, and cyclobenzaprine

Discussion

• Increasing evidence supports the use of regional

anesthesia to reduce opioid consumption

• Given our patient’s high opioid requirements at

baseline and his additional sources of cancer-related

pain, we knew he would still require at least his

baseline opioids to control his pain

• Despite unchanged MMEs after catheter placement,

saw improvement in endpoints such as sleep,

willingness to participate in PT, subjective pain score,

and willingness to discharge

• Overall, this case highlights that while regional

anesthesia is often used to reduce opioid

consumption, it can have additional benefits

especially in the chronic pain population

Resources

• Shinaman RC, Mackey S. Continuous peripheral nerve blocks. Curr Pain Headache Rep.

2005 Feb;9(1):24-9. doi: 10.1007/s11916-005-0071-y. PMID: 15625022.

• Joshi G, Gandhi K, Shah N, Gadsden J, Corman SL. Peripheral nerve blocks in the

management of postoperative pain: challenges and opportunities. J Clin Anesth. 2016

Dec;35:524-529. doi: 10.1016/j.jclinane.2016.08.041. Epub 2016 Oct 20. PMID: 27871587.

• Gautier, P., Vandepitte, C., & Gadsden, J. (2024, November 1). Ultrasound-guided

interscalene brachial plexus nerve block. NYSORA.

https://www.nysora.com/techniques/upper-