An extended brachial plexus blockade with an original method of catheter fixation: clinical case

Abstract

BACKGROUND: For extended blockade of the brachial plexus from the supraclavicular access, the catheter is fixed in the supraclavicular region. Owing to the anatomical features of the supraclavicular fossa and the short inner part of the catheter, this fixation method cannot be fully considered reliable and convenient both for the personnel operating the catheter and the patient. The most convenient place for fixing the catheter is the infraclavicular region because of its flat surface. If a catheter is installed to the brachial plexus from the supraclavicular access and the catheter is passed under the skin in the infraclavicular region, then the catheter exit site on the skin will be located further from the surgical intervention area and the inner part of the catheter will be larger. CLINICAL CASE DESCRIPTION: This study describes a clinical case of blockade of the brachial plexus by interscalene access with catheterization for prolonged analgesia via supraclavicular access and fixation of the catheter under the skin in the subclavian region in an older patient with polymorbidity during surgical treatment of a closed fracture of the middle third of the humerus. In anesthetic provision, when inducing brachial plexus blockade via a supraclavicular approach, the catheter was fixed in the subcutaneous tunnel of the infraclavicular region for prolonged blockade of the brachial plexus. CONCLUSION: This fixation method prevented internal and external dislocation of the catheter, which contributed to high-quality and long-term postoperative analgesia, early patient activity, and absence of infectious complications and created comfortable conditions for the handling of the catheter for both the medical staff and the patient.