Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study

P Goffin; L Morales; E Jorcano; A Prats-Galino; M A Reina; X Sala-Blanch

doi:10.1016/j.redare.2024.02.027

Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study

Rev Esp Anestesiol Reanim (Engl Ed). 2024 Feb 29:S2341-1929(24)00049-0. doi: 10.1016/j.redare.2024.02.027. Online ahead of print.

Authors

P Goffin¹, L Morales², E Jorcano³, A Prats-Galino⁴, M A Reina⁵, X Sala-Blanch⁶

Affiliations

¹ Master's Degree in Advanced Medical Competencies, Regional Anesthesia Based on Human Anatomy, University of Barcelona, Barcelona, Spain; Department of Anesthesia, MontLegia Hospital, CHC Groupe Santé, Liège, Belgium. Electronic address: pierre.goffin@chc.be.
² Master in Advanced Medical Skills in Regional Anesthesia based in Anatomy, University of Barcelona, Barcelona, Spain.
³ Department of Radiology, Hospital ClÍnic, Barcelona, Spain.
⁴ Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain.
⁵ CEU-San-Pablo University School of Medicine, Madrid, and Madrid-Montepríncipe University Hospital, Madrid, Spain; Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States.
⁶ Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain; Department of Anesthesia, Hospital Clínic, Barcelona, Spain.

PMID: 38431047
DOI: 10.1016/j.redare.2024.02.027

Abstract

Background: Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model.

Method: Eight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers. Computed tomography (CT) confirmed the location of the catheter tip after injection of 1 ml of contrast medium. We performed a series of standardized shoulder movements during a simulated shoulder physiotherapy session in cadavers. Following this, we administered 1 ml of methylene blue through the catheters, and then performed anatomical dissections to accurately identify the location of the catheter tips and compare them to their placement prior to the 'physiotherapy'.

Result: CT imaging confirmed the location of the catheter tips at the suprascapular notch in all cases. However, following physiotherapy, 2 catheters (25%) were found to have migrated - specifically, 1 was located in the supraspinatus muscle, and the other was located in the trapezius muscle.

Conclusion: Our findings suggest that catheter dislodgement may occur in approximately 25% of cases following simulated physiotherapy manipulation. However, further research is needed to determine the read incidence of catheter dislodgement in clinical practice.

Keywords: Anatomy; Anatomía; Bloqueos regionales continuos; Complicación de la anestesia regional; Continuous regional blocks; Fisioterapia; Nervio supraescapular; Physiotherapy; Regional anesthesia; Regional anesthesia complication; Suprascapular nerve; Tomografía; Tomography.