Continuous peripheral nerve block for ambulatory surgery. (Duke University, Durham, NC) Reg Anesth Pain Med 2001;26:209–214.

Abstract

In this study data was prospectively gathered for 1 year from 228 patients in an ambulatory surgery center. All continuous peripheral nerve blocks (CPNB) were performed using the Contiplex system to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for a loss of sensation. Patients were then discharged. The initial peripheral block was successful in 94% of the patients. Failed nerve block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of the patients at 24 hours, and 8% of the patients required more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit, only 4 patients (1.7%) required treatment for nausea. At 24 hours and 7 days postsurgery, no patient reported a dysesthesia. Conclude that CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects.Comment by Alan David Kaye, M.D., Ph.D., Erin Bayer, M.D. This study demonstrates the efficacy of the Contiplex system (CPNB) in providing surgical anesthesia and postoperative analgesia through CPNB. Despite the efficacy of CPNB, which could provide longer duration of postoperative analgesia than single injection block, it is not widely used due to lack of available equipment. Contiplex system utilizes a connector for a nerve stimulator attached to a 18‐gauge Tuohy needle. It allows for aspiration of blood, injection of local anesthesia and passage of a peripheral nerve catheter. This study demonstrated in an ambulatory surgery center with 228 patients, CPNB was used for 27 different types of surgical procedures which involved 5 different block sites. Success rates were 94% for initial peripheral block while 6% required general anesthesia. Patients required less postoperative analgesia. The incidence of postoperative side effects such as nausea and vomiting were minimal. Not a single patient reported dissatisfied with a 7‐day telephone follow‐up. A disadvantage of this technique is the use of an 18‐gauge needle and potential for vascular and/or nerve injuries, which did not occur in this study. Though previous studies have demonstrated the efficacy of the CPNB in inpatients, this is an important study focused on outpatients. A larger study group will be valuable in future studies.