Perineural catheter placement for total shoulders

[pocafx]

In fellowship we'd place the block in the preop area and start the OnQ pump during the case after positioning. Our surgeons preferred beach chair, so it was it just easier to hook it up after all the acrobatics. We'd use Mepivacaine to place the catheter for 1) quick verification that the block was working and 2) have surgical block for the procedure. Our OnQ infusions would be 0.2% Ropivacaine at 6 cc/hr. Catheter would be preinserted into tuohey needle, inserted into skin to desired location (usually deep to C6 nerve roots), once local spread sufficient, catheter could be threaded. Takes some practice, but you can do it all with one hand while visualizing the catheter placement on US. In terms of securing. Dermabond the insertion site to minimize leakage, wrap the catheter below the neck around to the contralateral shoulder and secure it down on the chest just below the clavicle. Lots of tegaderm. In fellowship, had maybe 4-5 catheters fail, only a few got pulled prematurely. For our RCR/TSA, it wasn't uncommon for our patients to have zero pain for 3 days...

PS Exparel is for suckers..

How do you give local with the catheter preinserted in touchy

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[mtbtx]

Sounds like the VM method.. thread catheter to the end or tip of touhy, add attachment to proximal end of catheter, and you can deliver local directly through the catheter while threaded into the touhy. When happy with spread, leave catheter in place by slowly drawing out touhy while making sure catheter doesn’t migrate.