Original article
Dislodgment of continuous suprascapular nerve block catheters after physiotherapy: A cadaver study
Desplazamiento de los catéteres para bloqueo continuo del nervio supraescapular tras fisioterapia: estudio en cadáveres
P. Goffina,b,
, L. Moralesc, E. Jorcanod, A. Prats-Galinoe, M.A. Reinaf,g, X. Sala-Blanche,h
Corresponding author
a Master's Degree in Advanced Medical Competencies, Regional Anesthesia Based on Human Anatomy, University of Barcelona, Barcelona, Spain
b Department of Anesthesia, MontLegia Hospital, CHC Groupe Santé, Liège, Belgium
c Master in Advanced Medical Skills in Regional Anesthesia based in Anatomy, University of Barcelona, Barcelona, Spain
d Department of Radiology, Hospital ClÍnic, Barcelona, Spain
e Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain
f CEU-San-Pablo University School of Medicine, Madrid, and Madrid-Montepríncipe University Hospital, Madrid, Spain
g Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States
h Department of Anesthesia, Hospital Clínic, Barcelona, Spain
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"apellidos" => "Sala-Blanch" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0040" ] ] ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Master's Degree in Advanced Medical Competencies, Regional Anesthesia Based on Human Anatomy, University of Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Anesthesia, MontLegia Hospital, CHC Groupe Santé, Liège, Belgium" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Master in Advanced Medical Skills in Regional Anesthesia based in Anatomy, University of Barcelona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Radiology, Hospital ClÍnic, Barcelona, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Human Anatomy and Embryology, University of Barcelona, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "CEU-San-Pablo University School of Medicine, Madrid, and Madrid-Montepríncipe University Hospital, Madrid, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, United States" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Department of Anesthesia, Hospital Clínic, Barcelona, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Desplazamiento de los catéteres para bloqueo continuo del nervio supraescapular tras fisioterapia: estudio en cadáveres" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2428 "Ancho" => 1207 "Tamanyo" => 437465 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A: Left shoulder dissection - Posterior superior view. 1: suprascapular nerve (yellow), 2: superior transverse scapular ligament (green), 3: supraspinatus muscle, 4: scapular spine, 5: marker (blue), 6: clavicle, 7: supraspinous fossa, 8: trapezius muscle.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">B: Left shoulder x-ray 3D anatomy reconstruction – Posterior superior view. 1: catheter (partial view), 2: catheter distal orifice, 3: suprascapular notch, 4: scapular spine, 5: acromion, 6: clavicle, and 7: supraspinous fossa.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Continuous peripheral nerve block (cPNB) after surgery gives effective post-operative pain management, reduces hospital stay, and allows early start of rehabilitation.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Successful cPNB relies on accurate placement and maintenance of catheters in specific perineural fat compartments. These are the ideal targets for local anaesthetic agents, and the catheter must remain in place for several days.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Secondary block failure, i.e., failure of cPNB after a specific period, can be caused by catheter dislodgement, leakage, disconnection, or malfunction of the infusion pump, among other factors.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Although cPNBs are widely utilized in clinical practice, there is a need for a clearer understanding and description of catheter displacement, which is likely to be underestimated. A study in healthy volunteers reported an overall catheter displacement rate of approximately 15%, and showed a significant correlation between catheter maintenance time and the rate of dislodgement.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Continuous suprascapular nerve blocks (SSNB) are used to manage chronic shoulder pain, and are combined with physiotherapy protocols in patients with glenohumeral adhesive capsulitis and acute postoperative shoulder pain.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Based on the objectives of our research group,<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> we designed this anatomical study to analyse the rate of continuous SSNB catheter dislodgement after a simulated routine physiotherapy session, to determine the resulting anatomical consequences, and describe the final position of the catheter tip after physiotherapy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">Eight shoulder regions from 8 unembalmed cryopreserved cadavers obtained following the regulations of our Ethics Committee and with no history of shoulder injury or prior shoulder surgery were included in this study. The cadavers were positioned in the sitting position and kept in the laboratory at a room temperature of 20 °C for at least 4 h before the start of the study.</p><p id="par0030" class="elsevierStylePara elsevierViewall">An anaesthesiologist with experience in ultrasound-guided regional anaesthesia techniques placed the suprascapular nerve (SSN) catheters under ultrasound guidance using a modified Price's technique.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Another experienced anaesthesiologist verified and approved catheter placement and location.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Ultrasound-guided catheter placement</span><p id="par0035" class="elsevierStylePara elsevierViewall">The anaesthesiologist placed a high-frequency linear ultrasound probe (13−6 MHz) (Sonosite M-Turbo; Bothell, WA) on the superior aspect of the scapular spine to identify the supraspinous fossae deep to the supraspinatus muscle. The probe was then moved laterally and tilted anteriorly to visualize the suprascapular notch. The suprascapular nerves were not individually identifiable due to their typical location in the fat compartments beneath the suprascapular muscle. Using an in-plane technique, the anaesthesiologist inserted the ultrasound needle (Tuohy Ultra-360 18, B-Braun Contiplex, Melsungen, Germany) in a medial to lateral direction, targeting the estimated nerve locations beneath the transverse ligaments near the supraspinous fossae in proximity to the suprascapular notch. Under direct ultrasound guidance, the catheter (B-Braun Contiplex100 mm catheter, Melsungen, Germany) was inserted through the needle, extending 1 cm beyond the tip at the target position. The catheter was then secured with a single Ethilon 4.0 (Ethicon®) suture as close as possible to the puncture site and covered with adhesive tape (3 M Tegaderm™ film [10 × 12 cm]). One ml of contrast medium was injected through the catheter to mark the catheter tip.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Computed tomography (CT)</span><p id="par0040" class="elsevierStylePara elsevierViewall">After performing the nerve block, CT scans (CT Somatom Definition Flash, Erlangen, Germany; 2 × 128 stellar detector) were used to verify and record the position of the catheter tip, which was deemed to be correctly placed if it was within 10 mm of the supraspinous notch. Axial, sagittal, and coronal 1-mm slices of the shoulder area including the clavicle and scapula were obtained, extending from 1 cm above the acromion to 1 cm below the apex of the scapula and from the midline of the sternum to the skin. Three-dimensional computerized reconstructions were made for each specimen using the internal software of CT scan. A specialized radiologist analysed the images.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Simulated physiotherapy</span><p id="par0045" class="elsevierStylePara elsevierViewall">With the cadavers in a sitting position, we applied standardized physiotherapy manoeuvres to the shoulders.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> One investigator stabilised the body while another qualified physical therapist performed the Forthomme shoulder rehabilitation protocol, repeating each series 3 times with a 10-minute rest period between series. Each series consisted of 6 arm abductions, adductions, anterior elevations, posterior elevations, internal rotations, and external rotations. Then, we injected 1 ml of a methylene blue solution through the catheters to mark the catheter tip position after physiotherapy.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Dissection</span><p id="par0050" class="elsevierStylePara elsevierViewall">The suprascapular fossae of the shoulders of 8 cadavers were dissected. The dissection involved removing the skin, subcutaneous tissue, trapezius, and erector spinae muscle to the depth of the supraspinatus muscle. The supraspinatus muscle was then separated from the scapula, starting from the medial aspect and moving laterally. After identifying the suprascapular notch, further dissection was performed to locate the nerve, catheter, and the spread of methylene blue. The position of the tip of the catheter after the physiotherapy session was determined by measuring the distance between the suprascapular notch and the mark made by the methylene blue. A distance greater than 15 mm from the notch indicated a "dislodged catheter."</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0055" class="elsevierStylePara elsevierViewall">This study included a total of 8 shoulders - 2 right and 6 left. Between 350 and 400 CT slices were obtained from each shoulder and were used to generate 3D reconstructions.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The CT images confirmed that prior to physiotherapy, all catheter tips were correctly positioned within 10 mm of the suprascapular notches, as shown in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–4</a>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Following the simulated physiotherapy session, anatomical dissections showed that the catheter tips remained in their original locations in 6 out of the 8 cadavers (75%), as indicated by the methylene blue dye around the SSN and its branches in <a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1–3</a>. However, in 2 specimens (25%), the blue dye was observed in the supraspinatus and trapezius muscles, respectively, at a distance greater than 15 mm from the suprascapular notch, without staining the branches of the SSN (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><p id="par0070" class="elsevierStylePara elsevierViewall">Overall, the catheter tips were correctly positioned in their presumed locations in 6 out of the 8 specimens after physiotherapy.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In our study, anaesthesiologists placed the SSNB catheters under ultrasound guidance, and correct positioning was confirmed by CT scan prior to the simulated physiotherapy session. This approach allowed us to show unequivocally that the catheters were successfully inserted in close proximity to the nerves within the correct fascial compartments. However, following the physiotherapy session, 2 out of the 8 catheters became dislodged and migrated away from the suprascapular notch and nerve, as shown in our anatomical dissection. In a recent review article, the authors suggested that secondary failure due to catheter migration is common and clinically significant.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Given the paucity of studies available, it is impossible to determine the average migration distance, and incidence varies widely from 5% to 40%. Moreover, a comparable method of catheter placement and catheter tip position confirmation causing secondary failure has yet to be well documented.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">An ultrasound study in healthy volunteers reported a catheter dislodgement rate of 15% (5% and 25% for interscalene and femoral nerve catheters, respectively) after 5 h.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> In another study of popliteal sciatic nerve catheters, displacement – confirmed by magnetic resonance imaging 48 h after insertion – occurred in 10% of cases.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In this study, however, the authors do not describe how accuracy of the initial catheter tip location was confirmed, and described the insertion technique as a risk factor for dislodgement: incidence was 10% when the catheter was inserted parallel to the sciatic nerve, but as high as 40% when it was inserted perpendicular to the nerve. Ilfeld,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> however, concluded that the incidence of dislodgement in randomized control trials and large series was surprisingly low.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The shoulder is one of the most mobile joints in the human body. Our protocol included a simulated intensive routine physiotherapy session in which the shoulder was moved in all directions. A study in out-patients undergoing hand surgery analysed the incidence of catheter dislodgement on the first postoperative day, and reported a failure rate of 19% and 26% for the infraclavicular and supraclavicular blocks, respectively.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In this study, the conditions and incidence of dislodgement were comparable to ours (although we did not attempt to perform an epidemiological study in catheter dislodgement), but catheters were secured using SteriStrips™ and OPSITE™ adhesive dressings, while in our study they were sutured into position and covered with adhesive dressings.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In clinical practice, catheter displacement or accidental removal is a major problem. Various methods, such as tapes, sutures, subcutaneous tunnelling, or tissue glue have been used to secure catheters and extend their lifespan. Dermatological glue has shown potential in preventing catheter leakage and reducing premature dislodgement<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>; however, a review of peripheral nerve catheters found that glue or tape for catheter fixation did not reduce the rate of secondary cPNB failure.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Moreover, difficulties in catheter removal when glue is used have also been reported.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Comparisons between studies are complicated due to assessment bias and differences in insertion techniques, equipment and infusion regimens, and anatomical variations.</p><p id="par0095" class="elsevierStylePara elsevierViewall">As the protocol utilized in this study is designed for cases involving intensive mobilization under regional anaesthesia, it is important to note that the dislocation rate within these specific conditions cannot be generalized to postoperative situations without intensive mobilization. Despite the intense mobilization, the observed dislodgement rate was found to be similar to that reported in the literature. Perineural catheters for continuous nerve blocks are often placed under ultrasound-guidance, and the outcome is generally positive, although secondary failure rates of up to 25% have been reported.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,11</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">This study had some limitations. First, it was an observational study based on a small number of specimens. As an experimental model, we found the mobility of the cadaveric specimens to most closely reflect reality.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Another limitation is that the positions of the catheters before and after physiotherapy manipulations were marked with a similar volume of dye and documented using CT scans and anatomical dissection. Although a small volume of contrast and methylene blue was used to limit the spread and give a more precise location, there is no reason to believe that the CT scans with small contrast volumes and the anatomical dissections with the same marker volume are not comparable.</p><p id="par0110" class="elsevierStylePara elsevierViewall">This study shows that catheter displacement in continuous peripheral nerve blocks is not uncommon, particularly during rehabilitation manoeuvres. However, it is important to note that catheter displacement does not necessarily result in loss of effectiveness due to the spread effect of local anaesthetics.</p><p id="par0115" class="elsevierStylePara elsevierViewall">In conclusion, we have shown that 2 out of 8 ultrasound-guided continuous nerve block catheters confirmed on CT scan became dislodged after a simulated physiotherapy session. Risk of dislodgement, therefore, should be considered during patient management.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare no conflicts of interest</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare no sources of funding</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Clinical trial number and registry URL</span><p id="par0130" class="elsevierStylePara elsevierViewall">Not applicable.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Adherence to STROBE recommendation</span><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Patient consent for publication:</span> Not required.</p><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ethics approval:</span> This study was performed under the University of Barcelona’s regulations, which included the consent of the first person before body donation.</p><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Prior Presentations</span>: The 39th Annual ESRA congress (June 2022 – Thessaloniki ; Abstract number 48).</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Summary statement</span><p id="par0150" class="elsevierStylePara elsevierViewall">This study estimates the possibility of dislodgement of ultrasound-guided continuous nerve block catheters. CT scans confirmed the placements of the continuous suprascapular nerve block catheter after placement. After a routine program of simulated physiotherapy of shoulder mobilization in a fresh cadaver dissection revealed an approximately one in four incidences of dislodgement, correlating with reported clinical experience.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Authors’ contributions</span><p id="par0155" class="elsevierStylePara elsevierViewall">PG: Project development, Data collection and management, data analysis, and manuscript writing. LM: Data collection and analysis. EJ: Data collection. APG: manuscript editing. MAR: Data analysis, manuscript editing. XSB: Conceived the concept and designed the study, Project development, data analysis, manuscript writing, and editing. All authors have read and approved the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:15 [ 0 => array:3 [ "identificador" => "xres2166595" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1837411" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2166594" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1837412" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Ultrasound-guided catheter placement" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Computed tomography (CT)" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Simulated physiotherapy" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Dissection" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflicts of interest" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Funding" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Clinical trial number and registry URL" ] 11 => array:2 [ "identificador" => "sec0060" "titulo" => "Adherence to STROBE recommendation" ] 12 => array:2 [ "identificador" => "sec0065" "titulo" => "Summary statement" ] 13 => array:2 [ "identificador" => "sec0070" "titulo" => "Authors’ contributions" ] 14 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-10-03" "fechaAceptado" => "2023-10-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1837411" "palabras" => array:7 [ 0 => "Suprascapular nerve" 1 => "Continuous regional blocks" 2 => "Regional anesthesia complication" 3 => "Tomography" 4 => "Anatomy" 5 => "Regional anesthesia" 6 => "Physiotherapy" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1837412" "palabras" => array:6 [ 0 => "Nervio supraescapular" 1 => "Bloqueos regionales continuos" 2 => "Complicación de la anestesia regional" 3 => "Tomografía" 4 => "Anatomía" 5 => "Fisioterapia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">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'.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Result</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">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.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Method" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Result" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Antecedentes</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">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.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Método</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">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 compararlas con su localización previa a la “fisioterapia”.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">La imagen de TC confirmó la localización en todos los casos de los extremos del catéter en la muesca supraescapular. Sin embargo, tras la fisioterapia, se encontró que dos catéteres (25%) habían migrado y, en especial, uno fue localizado en el músculo supraespinoso y el otro en el músculo trapecio.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Nuestros hallazgos sugieren que el desplazamiento del catéter puede producirse en cerca del 25% de los casos tras la manipulación mediante fisioterapia simulada. Sin embargo, es necesaria más investigación para determinar la incidencia real de los desplazamientos del catéter en la práctica clínica.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Antecedentes" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2538 "Ancho" => 1207 "Tamanyo" => 441109 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A: Left shoulder dissection – Posterior superior view. 1: suprascapular nerve (yellow), 2: sensory branch suprascapular nerve (yellow), 3: motor branch suprascapular nerve (yellow), 4: scapular spine, 5: acromion, 6: superior transverse scapular ligament (green), 7: marker (blue), 8: supraspinous fossa, 9: clavicle, and 10: infraspinatus muscle.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">B: Left shoulder x-ray 3D anatomy reconstruction – Posterior superior view. 1: catheter (partial view), 2: catheter distal orifice, 3: suprascapular notch, 4: scapular spine, 5: acromion, 6: filter, 7: supraspinous fossa, and 8: clavicle.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2428 "Ancho" => 1207 "Tamanyo" => 437465 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A: Left shoulder dissection - Posterior superior view. 1: suprascapular nerve (yellow), 2: superior transverse scapular ligament (green), 3: supraspinatus muscle, 4: scapular spine, 5: marker (blue), 6: clavicle, 7: supraspinous fossa, 8: trapezius muscle.</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">B: Left shoulder x-ray 3D anatomy reconstruction – Posterior superior view. 1: catheter (partial view), 2: catheter distal orifice, 3: suprascapular notch, 4: scapular spine, 5: acromion, 6: clavicle, and 7: supraspinous fossa.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 2676 "Ancho" => 1207 "Tamanyo" => 407370 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A: Left shoulder dissection – Posterior superior view. 1: suprascapular nerve (yellow), 2: suprascapular nerve artery (red), 3: superior transverse scapular ligament (green), 4: supraspinous muscle, 5: supraspinous fossa, 6: scapular spine, 7: clavicular, and 8: marker (blue).</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">B: Left shoulder x-ray 3D anatomy reconstruction – Posterior superior view. 1: catheter (partial view), 2: catheter distal extremity, 3: suprascapular notch, 4: supraspinous fossa, 5: scapular spine, 6: acromion, and 7: clavicula.</p>" ] ] 3 => array:8 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 2780 "Ancho" => 1207 "Tamanyo" => 482596 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A: Left shoulder dissection – Posterior superior view. 1: suprascapular nerve (yellow), 2: suprascapular artery (red), 3: supraspinous muscle, 4: supraspinous fossa, 5: scapular spine, 6: marker (blue), 7 superior transverse scapular ligament (green), 8: suprascapular nerve (sensorial branch), 9: trapezius muscle, and 10: infraspinatus muscle.</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">B: Left shoulder x-ray 3D anatomy reconstruction – Posterior superior view. 1: catheter (partial view), 2: catheter distal extremity, 3: supraspinous fossa, 4: suprascapular notch, 5: acromion. 6: scapular spine, 7: clavicula, 8: filter.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Peripheral nerve catheters: A critical review of the efficacy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.W. 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