Ultrasound-guided interscalene catheters performed under general anesthesia in a patient with Huntington's disease

The placement of interscalene nerve blocks in adults under general anesthesia remains controversial. There have been reports of patients who suffered permanent losses of cervical spinal cord function during this practice; however, these cases employed long needles and paresthesia or nerve stimulator techniques with high stimulation currents. As a result, practitioners currently use short needles for interscalene block and value feedback from patients who are awake. Interscalene catheters, because they require large bores and occasionally longer needles, are unlikely to be used on anesthetized patients with traditional techniques. An ultrasound technique, however, may be able to change current thinking toward the placement of interscalene catheters under general anesthesia. Ultrasound permits direct visualization of the needle, nerves, and local anesthetic spread and may decrease the risk of catastrophic complications. As in children, in whom awake placement is extremely difficult or even impossible, certain adult patient populations may only be offered the advantages of a peripheral nerve catheter if it is placed after the induction of general anesthesia. We report the case of a patient with Huntington's disease who was only able to undergo a total shoulder arthroplasty following ultrasound-guided placement of a continuous interscalene block under general anesthesia.