title: Preliminary experience with a novel ultrasound-guided supraclavicular perineural catheter insertion technique for perioperative analgesia of the upper extremity.
abstract: OBJECTIVE
  Brachial plexus perineural catheters provide specific analgesia for upper extremity surgery. Although single-injection ultrasound-guided supraclavicular blocks have been described, little is known about the efficacy of perineural catheters inserted using this approach. We present our experience with ultrasound-guided supraclavicular perineural catheters for distal upper extremity surgery.
  
  
  METHODS
  In this case series, 10 patients who underwent upper extremity surgery for orthopedic trauma at a tertiary care university hospital received a supraclavicular brachial plexus perineural catheter for postoperative pain management. In all patients, a nonstimulating catheter was inserted using an ultrasound-guided technique with the catheter tip remaining under direct vision until placement needle withdrawal. Postoperatively, a perineural ropivacaine, 0.2%, infusion was administered at a basal rate of 6 mL/h with a patient-controlled bolus of 4 mL and a lockout interval of 30 minutes.
  
  
  RESULTS
  Of the 10 patients, all had successful perineural catheter placement. Patients required a median (range) of 0 (0-100) μg of fentanyl for catheter insertion analgesia. There were no vascular punctures or other direct procedure-related complications. Catheters were maintained for a median (range) of 4 (2-5) days in both hospitalized and ambulatory patients. Median (range) pain scores on postoperative days 1 and 2 were 5 (0-7) and 4 (3-6), respectively, on a numeric rating scale. Three patients' catheters were removed by patient request or dislodged on postoperative day 1.
  
  
  CONCLUSIONS
  Supraclavicular brachial plexus perineural catheter insertion using ultrasound guidance is feasible and deserves further study with a randomized controlled trial comparing this relatively new technique with more established approaches.
authors.affiliation: Department of Anesthesiology, University of California, San Diego, California, USA.
authors.forename: Justin W
authors.initials: JW
authors.lastname: Heil
authors.forename: Brian M
authors.initials: BM
authors.lastname: Ilfeld
authors.forename: Vanessa J
authors.initials: VJ
authors.lastname: Loland
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D001917:Brachial Plexus / Q000000981:diagnostic imaging; D002404:Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain; D059035:Perioperative Period; D000077212:Ropivacaine; D018084:Ultrasonography, Interventional / Q000379:methods*; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery*; D055815:Young Adult
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine