Continuous shoulder analgesia via an indwelling axillary brachial plexus catheter

Continuous interscalene brachial plexus blockade can provide anesthesia and analgesia in the shoulder region. Difficulty accessing the interscalene sp ace and premature displacement of interscalene catheters may preclude their use in certain situations. We present two case reports in which a catheter was advanced from the axilla along the brachial plexus sheath to the inter scalene space to provide continuous cervicobrachial plexus analgesia. In th e first case report, previous neck surgery made the anatomic landmarks for performing an interscalene block very difficult. An epidural catheter was a dvanced from the axillary brachial plexus sheath to the interscalene space under fluoroscopic guidance. This technique provided both intraoperative an algesia for shoulder surgery as well as 24-hour postoperative analgesia by an infusion of 0.125% bupivacaine. In the second case report, a catheter wa s inserted in a similar fashion from the axillary to the interscalene space to provide 14 days of continuous analgesia in the management of complex re gional pain syndrome. We have found that this technique allows us to secure the catheter more easily than with the traditional interscalene approach a nd thus prevents premature dislodgment. This approach may be a suitable alt ernative when either an interscalene or an infraclavicular catheter may not be inserted. (C) 2000 by Elsevier Science Inc.