• John G Antonakakis, Brian D Sites, and Jeffrey Shiffrin.
• Department of Anesthesiology and Orthopedic Surgery, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA. ja5z@virginia.edu
• Reg Anesth Pain Med. 2009 Jan 1;34(1):64-8.

Background And ObjectivesThe posterior approach to performing a continuous brachial plexus block at the level of the nerve roots has been described using traditional superficial landmarks. We describe an ultrasound-guided approach for the placement of a continuous interscalene brachial plexus catheter at the level of the nerve roots using a posterior approach. In addition, we provide the clinical characteristics of the first 16 catheters placed at our institution utilizing this approach.MethodsSixteen patients having major shoulder surgery underwent ultrasound-guided placement of a posterior interscalene catheter at the level of the nerve roots. After generation of an optimized short axis image of the neural and vascular structures in the midneck, a 17-gauge Tuohy needle was directed into the skin between the levator scapulae and middle scalene muscles. Using the in plane approach, the needle was advanced until the tip was located between C5 and C6 nerve roots. Following a bolus injection of local anesthetic, a catheter was threaded 2 to 4 cm and secured. Visualization of the spread of local anesthetic through the catheter was used to dynamically confirm correct perineural catheter location. The characteristics of these catheters were assessed including dislodgment, postoperative opioid consumption, complications, and patient satisfaction.ResultsAll 16 catheters were successfully placed. There were no unintended catheter dislodgments. Patient satisfaction was high and postoperative opioid consumption was minimal.ConclusionsResults suggest the use of ultrasound for placing a continuous interscalene nerve catheter via the posterior approach is a viable technique that offers an alternative to the more conventional non-image-guided superficial landmark techniques.

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