Abstract
Background: Continuous peripheral nerve block catheter has been widely used clinically.A small percentage of catheters usually need adjustment after placement.However, there is no study on how to adjust catheter in the literature. Methods: Twelve fresh pork legs were randomly allocated into one of two groups, perineural catheter advanced 5 cm or less beyond needle tip (N=6), or more than 5 cm beyond needle tip (N=6). For both groups, ultrasound guided sciatic nerve block was performed with the “in-plane” approach.The anatomic landmarks and the locations of the sciatic nerve block equate to the Labat approach in humans. Thirty milliliter of normal saline was used to dissect the epineuron space before threading 20G soft non-stimulating catheter. The catheter was pulled back in onecentimeter increments at the level of the skin while the location of the tip of the catheter was identified by fluoroscopy after each centimeter pull back. The main outcome was the catheter tip movement. Results: The catheter tips advanced either cephalic or caudally without dominance trend, while most catheter tips located superficially to the needle tip (11 out of 12). In T 5 cm group, the catheter tip movement was initially 0.17 ± 0.11 cm per centimeter pull back, then increased to 0.25 ± 0.12 cm once the catheter tip was less than 5 cm beyond the initial depth of needle tip. Conclusions: We recommend that adjustment of the CPNC should base on the initial depth of the needle tip since the initial catheter tip movements among these over threaded catheters are very limited, and it would not be efficient in clinical practice to adjust peripheral nerve block catheter by pulling by centimeter increment.
Highlights
Peripheral nerve blockade is an effective and proven method of providing anesthesia and analgesia to many surgical patients
Continuous Peripheral Nerve Catheter (CPNC) further extends the scope of care we could offer to our patients by extending the duration of post-operative analgesia
There is no consensus among anesthesiologists in terms of ideal distance of catheter advancement beyond the needle tip, while most practicing anesthesiologists tend to thread 5-10 cm beyond the needle tip due to concerns of potential dislodgement
Summary
Peripheral nerve blockade is an effective and proven method of providing anesthesia and analgesia to many surgical patients. Continuous Peripheral Nerve Catheter (CPNC) further extends the scope of care we could offer to our patients by extending the duration of post-operative analgesia. There are two basic types of catheters, stimulating catheter and non-stimulating catheter. The approaches of placing non-stimulating catheters are divided into two basic categories: direct thread technique and hydro-dissection before threading technique. The hydro-dissection before threading technique is more popular among anesthesiologists, mainly due to its effectiveness and efficiency. Continuous peripheral nerve block catheter has been widely used clinically. A small percentage of catheters usually need adjustment after placement. There is no study on how to adjust catheter in the literature
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