50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Surgical Removal of a Tunneled Interscalene Peripheral Nerve Catheter

Janet Adegboye, MD MS; Chelsea Teare, MD; Wael Ali Sakr Esa, MD, MBA, PhD; Sree Kolli, MD

Cleveland Clinic Foundation, Department of Anesthesiology, Cleveland, OH

Case Report Timeline

Postoperative Day (POD) 0

•67-year-old man underwent a right total shoulder arthroplasty under general anesthesia

•A right interscalene catheter was placed preoperatively under ultrasound guidance and tunneled posteriorly

POD 1

•The patient was discharged home with an ambulatory pump infusing ropivacaine 0.2% at 6 ml per hour

POD 4

•The catheter broke when the patient attempted to pull out the interscalene catheter at home

•Attempts at bedside removal were made in the emergency room, but the broken catheter remained coiled in his neck (Figure 1)

POD 6

•The patient underwent surgical removal of the retained catheter under monitored anesthesia care (Figure 2)

POD 14

•At his postoperative follow-up visits, his incisions were healing normally and he was neurovascularly intact with 0/10 pain

Discussion

•Benefits of subcutaneous tunneling of a peripheral nerve catheter:

•Lower rates of bacterial colonization

•Decreased risk of dislodgment

•Ensuring the catheter is away from the surgical field

•Risks of subcutaneous tunneling:

•Shearing of the catheter at the time of placement

•Significantly increasing the force required to remove the catheter

•Strategies that can assist with difficult catheter removal are position changes, holding traction, saline boluses, and inserting a stylet

•Ultimately if these methods are not able to successfully remove the retained catheter, the patient may need to undergo an interventional or surgical procedure for removal

Figure 1: X-ray showing retained catheter

Figure 2: Catheter fragment after removal

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

SURGICAL REMOVAL OF A TUNNELED INTERSCALENE PERIPHERAL NERVE CATHETER

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