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

• Published in: Revista española de anestesiología y reanimación (English ed.) 2024-04, Vol.71 (4), p.291-297
• Main Authors: Goffin, P., Morales, L., Jorcano, E., Prats-Galino, A., Reina, M.A., Sala-Blanch, X.
• Format: Article
• Language: English
• Subjects: 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
• ISSN: 2341-1929; 2341-1929
• DOI: 10.1016/j.redare.2024.02.027

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. 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'. 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. 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. Los bloqueos continuos de los nervios periféricos son de uso común para el manejo del dolor. Sin embargo, la incidencia de desplazamiento o migración del catéter es dudosa, pudiendo ser infraestimada y no denunciarse. Nuestro objetivo fue evaluar el posicionamiento del extremo del catéter supraescapular antes y después de la manipulación rutinaria y simulada mediante fisioterapia de hombro en un modelo cadavérico anatómico. Se colocaron ocho catéteres para bloqueo continuo y ecoguiado del nervio supraescapular en cadáveres frescos criopreservados. La tomografía computarizada (TC) confirmó la localización de la punta del catéter tras la inyección de 1 ml de medio de contraste. Realizamos una serie de movimientos estandarizados de hombro durante una sesión simulada de fisioterapia de hombro en cadáveres. Tras ello, administramos 1 ml de azul de metileno a través de los catéteres, y seguidamente realizamos disecciones para identificar con precisión la localización de las puntas del catéter y compar