[The use of the infraclavicular plexus catheter for treatment of perioperative and chronic pain].

Objectives: The aim of this prospective study was to evaluate the vertical infraclavicular approach to the brachial plexus for the insertion of a catheter to achieve continuous analgesia in postoperative patients and patients with chronic upper limb pain.

Methods: The brachial plexus was identified using the technique described by Kilka et al. and a flexible catheter (diameter 0.85 mm) was introduced 3-5 cm into the perineural sheath via the punction cannula. Regional analgesia was achieved by intermittent injection of local anaesthetic agent. Placement of the catheter, duration and effectiveness of treatment, complications and reasons for catheter removal were recorded using a standard protocol.

Results: A total number of 226 plexus catheters were placed in 210 patients. Consecutive regional analgesia for at least 48 h was possible in 88%. Analgesia was sufficient in 76% of patients up to the time of catheter removal. The median (minimum-maximum) duration of catheterisation in the whole collective was 7 days (1-240) and 11 days in patients with chronic pain. Almost 30% of the patients were treated for 10 days or longer and 4.4% were treated for 1 month or longer. Major complications occurred in only three cases, while technical problems and minor complications (redness at puncture site) occurred in 10% of cases.

Conclusions: The placement of an infraclavicular plexus catheter is a suitable method for pain management in the upper limb. This approach may have advantages in patients with severe injuries who cannot abduct the arm. Our results are encouraging in terms of catheterisation time, patient comfort and incidence of complications.