Novel Saline Injection Technique Reverses Continuous Costoclavicular Block: A Case Report

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Novel Saline Injection Technique Reverses Continuous Costoclavicular Block: A Case Report

If you’ve ever had shoulder surgery, you know post-operative pain management is critical. Many doctors use regional anesthesia—like a costoclavicular block—to numb the nerves around the shoulder, providing days of pain relief. But there’s a downside: once the block is in place, there’s no easy way to reverse it early if you’re stuck with unwanted numbness or immobility. Until now, that is.

A team of anesthesiologists from The Catholic University of Korea recently shared a case where a simple saline injection reversed a continuous costoclavicular block—offering new hope for patients and clinicians alike. Here’s what happened.

The Case: From Complete Numbness to Rapid Recovery

A 75-year-old man underwent right shoulder rotator cuff repair under general anesthesia. To manage post-op pain, his care team used a continuous costoclavicular block:

  1. They used ultrasound to locate the axillary artery/vein and brachial plexus (the nerve bundle controlling the arm).
  2. They injected 10mL of 0.375% ropivacaine (a local anesthetic) and inserted a small catheter for ongoing pain relief.
  3. After surgery, he received a patient-controlled analgesia (PCA) pump: a low dose of ropivacaine (0.2%) delivered continuously at 6mL/hour, with a 4mL backup dose if needed.

Twenty-five hours later, the man’s pain was perfect (0 out of 10 on the visual analog scale, or VAS). But he couldn’t move his right arm or feel anything in his fingers—complete motor and sensory blockade. The Acute Pain Service (APS) team rushed to check:

  • Ultrasound confirmed the catheter was in place (no nerve damage).
  • To test, they injected 15mL of normal saline (0.9%) through the catheter.

The result? Dramatic recovery in 15 minutes. The man could move his arm and fingers again. His sensation returned (except for mild tingling in his wrist), and his pain score rose to a manageable 3-4. He asked to keep the PCA running to avoid discomfort, and by post-operative day 3, the catheter was removed. A week later, he had no lingering issues.

Why Did Saline Work?

The team offered two plausible explanations for the rapid reversal—both rooted in basic science:

  1. Dilution of Local Anesthetic: Saline lowered the concentration of ropivacaine around the nerves. Local anesthetics block nerve signals only when their concentration is high enough. By adding saline, the ropivacaine level fell below the threshold needed to block signals—letting motor and sensory nerves work normally again.

  2. Sodium and pH Changes: Saline increased the sodium concentration around the nerves. This may have adjusted the pH (acidity/alkalinity) and ionization of the ropivacaine, speeding up how quickly the drug left the nerve cells.

Since the man was on a low dose of ropivacaine (0.2%), the saline was enough to push the concentration below the blocking level fast.

What This Means for Patients and Clinicians

This case is groundbreaking because it’s the first reported use of saline to reverse a continuous costoclavicular block—a peripheral nerve block common in shoulder surgery. For patients, it could mean less time stuck with a numb, immobile arm after surgery. For clinicians, it’s a potential tool to reverse blocks early if a patient has severe discomfort from immobility.

But it’s important to note: this is a single case report. The team stresses that more research (like randomized trials) is needed to confirm if saline works consistently and safely. It’s not a “proven method” yet—but it’s a promising start.

The Bottom Line

Regional anesthesia is a game-changer for post-operative pain, but its main downside is the lack of early reversal options. This case suggests saline—an inexpensive, widely available solution—could fill that gap for peripheral blocks like the costoclavicular block.

The study was published in the Chinese Medical Journal in 2021 by Jihyun Chung, Seunguk Bang, Youngin Lee, Woojin Kwon, and Kyudon Chung (all from the Department of Anesthesiology and Pain Medicine at The Catholic University of Korea). The patient gave informed consent for his case to be published, with steps taken to protect his identity.

For more details, you can read the full study at doi.org/10.1097/CM9.0000000000001774.

While we wait for more research, this case offers a glimmer of hope: sometimes, the simplest solutions can have the biggest impact.

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