{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T07:00:26Z","timestamp":1785394826487,"version":"3.55.0"},"reference-count":15,"publisher":"The Korean Society of Anesthesiologists","issue":"4","license":[{"start":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:00:00Z","timestamp":1783382400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["ekja.org"],"crossmark-restriction":true},"short-container-title":["Korean J Anesthesiol"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:p>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: 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.<\/jats:p>","DOI":"10.4097\/kja.26278","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:40:07Z","timestamp":1783384807000},"page":"446-454","update-policy":"https:\/\/doi.org\/10.4097\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Extrafascial out-of-plane continuous interscalene block using the C6 transverse process as a bony landmark -A case 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