Extrafascial out-of-plane continuous interscalene block using the C6 transverse process as a bony landmark -A case series.

BACKGROUND

Background

Extrafascial interscalene block has been proposed to reduce phrenic nerve involvement while maintaining analgesic efficacy for shoulder surgery. However, a reproducible continuous catheter technique using a clear anatomical landmark has not been well described.

CASE: We describe a case series of six patients undergoing shoulder surgery who received a continuous extrafascial interscalene block using the C6 transverse process as a bony landmark. Under ultrasound guidance, an 18-gauge Tuohy needle was advanced in a cranial-to-caudal out-of-plane trajectory toward the posterior tubercle of C6, and a catheter was placed within the middle scalene muscle. Continuous levobupivacaine infusion was maintained for 24 hours as part of multimodal analgesia.

CONCLUSIONS

Conclusions

This technique was associated with favorable postoperative analgesic profiles within a standardized multimodal regimen, without clinically apparent respiratory compromise. Given the absence of a control group, findings should be interpreted as hypothesis-generating. The C6 bony endpoint may improve reproducibility.