Case Report: Double Loop Knot Catheter in Plexus Brachialis

Introduction Peri-interventional complications during regional anesthesia are uncommon but do occur. Some of these complications include bleeding, catheter dislocation, catheter defect and nerve damage etc. In order to address such problems, it is important first to identify the problem and then with an interdisciplinary approach and with the use of modern diagnostic finally solve the problem.

Methods We present a case of a 53year- old- woman with humeral fracture, planned for an operation. An interscalene plexus block with the use of a catheter was chosen for the peri-operative pain control. However, because of some resistance while trying to extract the catheter, it was not removed. A CT-scan with contrast performed, revealed a double-loop formation of the catheter around the thorax aperture with a knot in the Scalenus Anterior Muscle. The need for the operative removal of the catheter through an anterior neck-dissection approach with exposure of the plexus cervicalis was necessary. The patient consented to the operation.

Results With this approach, important structures like the Common Jugularis Vein and the common Arteria Carotis were identified, isolated and preserved. The catheter was located around the plexus brachialis and the loop identified in the musculus scalenus anterior. Afterwards, the entangled catheter was extracted with no damage to the surrounding nerves or blood vessels.

Discussion During the removal of a peripheral nerve catheters in neck region, one should consider the possible dislocation and loop build up. A CT-scan with contrast is a reliable diagnostic tool in identifying this. A team approach is best used to manage this complication (in this case with the help of the ENT and Radiologist).

Poster-PDF A-1215.pdf

Conflict of interest

Der Erstautor gibt keinen Interessenskonflikt an.

Publikationsverlauf

Artikel online veröffentlicht:
13. Mai 2021