This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sandefo, I. Search for Related Content PubMed Articles by Sandefo, I.

---

LETTER TO THE EDITOR

Patient-Controlled Interscalene Analgesia After Shoulder Surgery: Catheter Insertion by the Posterior Approach

Department of Anaesthesiology and Intensive Care Medicine; Clinique Saint-Paul; Martinque, France; ignacesandefo{at}hotmail.com

In Response:

We thank Dr. Boezaart (1) for his interest in our article (2) and valuable comments. We would like to take the opportunity to address the issues point by point.

First, the misinterpretation of the "Y" as the Boezaart needle insertion point is unfortunate and was not intended. The Boezaart needle insertion point is "at the ‘V’ formed by the trapezius and levator scapulae muscles at the level of C6, between 4 and 12 cm lateral of the midpoint of the spinous process of C6" (3).

Second, in our study, only 2.5% of patients complained of cervical pain, which was easily treated with paracetamol or spontaneously resolved after catheter removal. In our experience with the posterior approach to the brachial plexus block, cervical pain ceased being an issue.

Third, the evidence of the inaccuracy of surface landmarks for the regional anesthesia technique is a major concern. Real-time imaging techniques are needed to improve the safety of regional anesthesia.

Last, we agree with Dr. Boezaart that the risk of pneumothorax should be very small with the posterior approach to the brachial plexus block.

References

1. Boezart AP. Patient-controlled interscalene analgesia after shoulder surgery: catheter insertion by the posterior approach. Anesth Analg 2006;102:xxx.
2. Sandefo I, Bernard J-M, Van Elstraete A, et al. Patient-controlled interscalene analgesia after shoulder surgery: catheter insertion by the posterior approach. Anesth Analg 2005;100:1496–8.[Abstract/Free Full Text]
3. Boezaart AP, Koorn R, Rosenquist RW Paravertebral approach to the brachial plexus: an anatomical improvement in technique. Reg Anesth Pain Med 2003;28:241–4.[Web of Science][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sandefo, I. Search for Related Content PubMed Articles by Sandefo, I.