Nerve Catheter Research Articles

Effective plexus anaesthesia in a patient with Ehlers–Danlos syndrome type III

Effective plexus anaesthesia in a patient with Ehlers–Danlos syndrome type III

Major Complications Associated with Femoral Nerve Catheters for Knee Arthroplasty: A Word of Caution

One thousand one hundred ninety patients underwent knee arthroplasty between January 2004 and July 1, 2007, and received an indwelling continuous infusion femoral catheter for postoperative ropivicaine pump infusion. Catheters were placed using electrical stimulation guidance. For the initial 469 patients (group 1), the continuous infusion ran for 2 to 3 days. In 721 patients, the infusion was discontinued 12 hours after surgery. There were 9 femoral nerve palsies (2 in group 1, 7 in group 2) and 8 major falls (0.7%). The overall complication rate was 1.5%, and the risk of permanent nerve injury was 0.2%. Patients should be made aware of these complications as part of the usual informed consent process before using this technique for postoperative pain control after knee arthroplasty. We did not observe fewer falls when the continuous infusion was stopped 12 hours after surgery.

Échec de retrait de cathéters nerveux périphériques : les nœuds, une complication à connaître

We observed three cases of knots after peripheral nerve catheterism. Catheter removal was impossible and required the intervention of an anaesthetist. This complication should be known and included in the training of nurses. The analgesic technique by peripheral nerve catheter is currently used for the treatment of acute postoperative pain and starts to be used for the treatment of chronic pain. The catheter removal should be included in a protocol. One solution might be the use of a network to meet all the complications that happen in continuous peripheral nerve blocks, particularly at home.

Bacterial Colonization After Tunneling in 402 Perineural Catheters: A Prospective Study

Bacterial colonization of peripheral nerve catheters is frequent, although infection is relatively rare. With central venous catheters, the tunneling of the catheter into the subcutaneous tissue significantly decreases catheter colonization and catheter-related sepsis. We evaluated the incidence of bacterial colonization in adult patients with tunnelized perineural nerve catheters. Peripheral nerve catheters placed under sterile conditions for postoperative analgesia were evaluated prospectively. After removal, they were analyzed for colonization. Quantitative culture was used as described by Brun-Buisson for intravascular catheters. The site of insertion was monitored daily for any signs of infection. Four-hundred-two patients were included in the study during a 2-yr period. The mean duration of peripheral nerve catheters was 48 h (47-50.4). Positive culture occurred in 25 catheters, indicating that the incidence of colonization was 6.22% (3.8-8.5). The microbiological analysis of the catheter tip cultures revealed coagulase-negative staphylococci in 72%. Twenty-two catheters of 25 catheters each had one microorganism, and for three catheters, two microorganisms were identified. No infection was found in any patient. The incidence of perineural catheter colonization is low with subcutaneous tunneling. Controlled randomized studies are warranted to determine whether this procedure decreases the risk for infection.

THA with a Minimally Invasive Technique, Multi-modal Anesthesia, and Home Rehabilitation: Factors Associated with Early Discharge?

Multimodal anesthetic and pain regimens with minimally invasive surgical approaches and rapid rehabilitation protocols are thought to decrease length of stay after hip replacement. We asked whether a program including these three elements could achieve 23-hour discharge in a group of 665 patients and whether the length of hospital stay was influenced by patient age, gender, body mass index, change in hemoglobin or estimated blood loss, duration of surgery (< or = 90 or > 90 minutes), or American Society of Anesthesiologists physical status classification. Of the 665 patients, 259 (38.9%) were discharged home with indwelling peripheral nerve catheters. Hospital discharge in less than 24 hours was achieved in 295 (44.4%) of the 665 patients. After discharge, 73.5% of patients required no home or outpatient nursing care or physical therapy. Eighteen (2.7%) dislocations, eight (1.2%) femoral fractures requiring surgery, and thirteen (2.0%) revision procedures occurred within 90 days. Female gender, increasing age, increasing estimated blood loss, and American Association of Anesthesiologists classification 3 or 4 increased length of stay. Additional study is needed to confirm these factors and develop prospective prediction rules to allow for an outpatient approach to joint arthroplasty. Level II, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Erythropoietin Protects against Local Anesthetic Myotoxicity during Continuous Regional Analgesia

Local anesthetics offer the benefits of extended analgesia with greater patient satisfaction and faster rehabilitation compared with intravenous morphine. These benefits, however, can be offset by adverse iatrogenic muscle pain caused by bupivacaine. Here, the authors describe the mechanisms of local anesthetic-induced myotoxicity and a partial protective effect of recombinant human erythropoietin (rhEPO). The authors developed a rat analgesia model with femoral nerve catheter and a cell culture model of human skeletal muscle myoblasts to study local anesthetic effects. Rats were randomly assigned to four different groups: daily intraperitoneal injection with 5,000 U/kg rhEPO or saline coupled to a perineural catheter injection with 1 ml/kg bupivacaine, 0.25%, or saline. In psoas rat muscle, oxygen consumption rates were measured using a Clark-type electrode in saponin-skinned fibers. Mitochondrial adenosine triphosphate synthesis rates were determined by bioluminescence. Enzymatic activity of mitochondrial respiratory chain complexes was measured on tissue homogenates using spectrophotometric procedures, and mitochondrial morphology was analyzed by transmission electron microscopy. In addition, the interaction between bupivacaine and rhEPO was investigated on human skeletal muscle myoblasts by fluorescence microscopy using mitotracker green and using the lipophilic cation JC-1. Bupivacaine caused impairment of mitochondrial structure and bioenergetics in rats. Human myoblasts treated with bupivacaine showed a dose-dependent decrease in mitochondrial membrane potential associated with unusual morphologies. Impairment of mitochondrial bioenergetics was prevented partially by the use of rhEPO coadministered with bupivacaine. The authors demonstrated a dose- and time-dependent protective effect of rhEPO against bupivacaine-induced myotoxicity in regional analgesia.

Continuous ilioinguinal nerve catheter infusions for iliac bone graft: postoperative pain control without adverse effects!

Continuous ilioinguinal nerve catheter infusions for iliac bone graft: postoperative pain control without adverse effects!

Ultrasound‐guided ulnar nerve catheter placement in the forearm for postoperative pain relief and physiotherapy

Consistent identification of peripheral nerves as well as placement of catheters for post-operative pain relief is possible with the aid of ultrasound. By blocking a single nerve rather than the entire extremity, pain can be eliminated without impairing motor function of the entire extremity, providing greater patient comfort. This report describes a case in which ultrasound-guided ulnar nerve catheter placement was performed in the forearm for post-operative pain relief following arthrolysis and tenolysis of the fifth finger. The ulnar nerve catheter allowed for excellent pain relief and completely painless physiotherapy without impairing motor function of the operated finger.

Stimulating nerve catheters in regional anaesthesia

Summary The practice of regional anaesthesia has evolved from mechanically stimulating a nerve with a needle and thereby eliciting paraesthesia to the fine art of using state-of-the art electrolocation using peripheral nerve stimulators and insulated needles. The stimulating nerve catheter is a very useful addition to the armamentarium of the regional anaesthesia practitioner. The stimulating nerve catheter makes it possible to verify the perineural location before delivering targeted continuous infusion of local anaesthetic for extended pain relief. The increasing use of ultrasound in echolocation of neural structures has added a new dimension to the popularity of peripheral nerve blocks.

Comparison of Continuous Infusion versus Automated Bolus for Postoperative Patient-controlled Analgesia with Popliteal Sciatic Nerve Catheters

This investigation was designed to compare a new methodology of automated regular bolus with a continuous infusion of local anesthetic for continuous popliteal sciatic block; both regimens were combined with patient-controlled analgesia (PCA). Fifty patients undergoing hallux valgus repair were randomly allocated to receive an infusion of 0.125% levobupivacaine administered through a popliteal catheter as an automated regular bolus (n = 25) or as a continuous infusion (n = 25), both combined with PCA. Postoperative pain scores, incremental doses delivered by the PCA, local anesthetic consumed per hour, and the need for rescue tramadol analgesia were recorded. Both dosing regimens provided similar postoperative analgesia. Consumption of local anesthetic (5.14 ml/h, 5-5.75 ml/h) and dose request from the PCA (1, 0-5.4) was lower in the automated bolus group as compared to the continuous infusion group (5.9 ml/h, 5.05-7.8 ml/h; doses by PCA: 6.5, 0-20.5; P < 0.05). The need for rescue tramadol was similar in the two groups. In continuous popliteal sciatic block, local anesthetic administered as an automated regular bolus in conjunction with PCA provided similar pain relief as a continuous infusion technique combined with PCA; however, the new dosing regimen reduced the need for additional PCA and the overall consumption of local anesthetic.

Ultrasound-guided posterior approach for the placement of a continuous interscalene catheter.

The posterior approach to performing a continuous brachial plexus block at the level of the nerve roots has been described using traditional superficial landmarks. We describe an ultrasound-guided approach for the placement of a continuous interscalene brachial plexus catheter at the level of the nerve roots using a posterior approach. In addition, we provide the clinical characteristics of the first 16 catheters placed at our institution utilizing this approach. Sixteen patients having major shoulder surgery underwent ultrasound-guided placement of a posterior interscalene catheter at the level of the nerve roots. After generation of an optimized short axis image of the neural and vascular structures in the midneck, a 17-gauge Tuohy needle was directed into the skin between the levator scapulae and middle scalene muscles. Using the in plane approach, the needle was advanced until the tip was located between C5 and C6 nerve roots. Following a bolus injection of local anesthetic, a catheter was threaded 2 to 4 cm and secured. Visualization of the spread of local anesthetic through the catheter was used to dynamically confirm correct perineural catheter location. The characteristics of these catheters were assessed including dislodgment, postoperative opioid consumption, complications, and patient satisfaction. All 16 catheters were successfully placed. There were no unintended catheter dislodgments. Patient satisfaction was high and postoperative opioid consumption was minimal. Results suggest the use of ultrasound for placing a continuous interscalene nerve catheter via the posterior approach is a viable technique that offers an alternative to the more conventional non-image-guided superficial landmark techniques.

Infectious Risk of Continuous Peripheral Nerve Blocks

Infectious Risk of Continuous Peripheral Nerve Blocks

The Safety and Efficacy of Extended Thromboprophylaxis With Fondaparinux After Major Orthopedic Surgery of the Lower Limb With or Without a Neuraxial or Deep Peripheral Nerve Catheter

Survey of Anesthesiology: December 2008 - Volume 52 - Issue 6 - p 315-316 doi: 10.1097/SA.0b013e31818bceb1

A Comprehensive Hip Fracture Program Reduces Complication Rates and Mortality

To evaluate the rate of postoperative complications, length of stay, and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients (the optimized program). Retrospective chart review with historical control. Orthopedic ward (110 beds) at a university hospital (700 beds). Five hundred thirty-five consecutive patients aged 40 and older (94%>or=60) hospitalized for hip fracture between January 1, 2003, and March 31, 2004. Three hundred and thirty-six patients (70.3%) were community dwellers before the fracture and 159 (29.7%) were admitted from nursing homes. The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block; an earlier assessment by the anesthesiologist; and a more-systematic approach to nutrition, fluid and oxygen therapy, and urinary retention. In the intervention group, the rate of any in-hospital postoperative complication was reduced from 33% to 20% (odds ratio=0.61, 95% confidence interval=0.4-0.9; P=.002). Rates of confusion (P=.02), pneumonia (P=.03), and urinary tract infection (P<.001) were lower in the intervention group than in the control group, and length of stay was 15.8 days in the control group, versus 9.7 days in the intervention group (P<.001). For community dwellers, 12-month mortality was 23% in the control group versus 12% in the intervention group (P=.02). Overall 12-month mortality was 29% in the control group and 23% in the intervention group (P=.2). The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality. Randomized clinical trials are needed to confirm these results and elucidate the elements of the program that have the greatest effect on clinical outcomes and mortality.

Atlas of Peripheral Nerve Blocks and Anatomy for Orthopaedic Anesthesia

Atlas of Peripheral Nerve Blocks and Anatomy for Orthopaedic Anesthesia Boezaart AP. Philadelphia: Saunders Elsevier, 2008. ISBN 978-1-4160-3941-9. 242 pages + DVD, $179.00. In the era of perioperative patient care, utilization of peripheral nerve blocks for intraoperative anesthetics as well as postoperative pain management is becoming increasingly common. As such, there is a great need for anesthesiologists to understand the key anatomical principles and techniques necessary to successfully perform peripheral nerve blocks. In this text and DVD, Boezaart presents the most relevant and commonly performed peripheral nerve blocks utilized for orthopedic surgery. The book is comprised of 19 chapters organized logically from cervical to sacral nerves. Prior to discussion of each peripheral nerve block, there is a chapter discussing pertinent anatomical principles, mainly through full-color illustrations, gross anatomy images, and surface anatomy figures. Concise text accompanies these images to further the reader's understanding of nerve location, motor innervation, and sensory innervation (including dermatomes and osteotomes). Subsequently, 16 peripheral nerve blocks are described in a step-by-step manner, including single injection and continuous catheter techniques. Coinciding detailed clinical photographs taken during actual peripheral nerve block placement solidify the text descriptions. Additionally, basic ultrasound images depict anatomical structures during ultrasound-guided approaches. References in the text to correlating DVD segments provide the reader reinforcement of anatomical principles as well as short video clips of single injection and continuous catheter techniques. The DVD narration is succinct and the video images are of high resolution with readily identifiable anatomical landmarks and easy to follow techniques. Beyond describing techniques, the author includes guidance on the appropriate choice of peripheral nerve block for specific types of orthopedic surgery, especially indications for placement of continuous peripheral nerve catheters. The author also provides practical advice for choosing local anesthetics for both single injection and continuous catheter peripheral nerve blocks based on type of surgery, anticipated postoperative pain, and postoperative physical therapy goals. Specific doses as well as recommendations for patient-controlled bolus doses through continuous catheters included in the text and DVD are very helpful especially for novice practitioners. Furthermore, the author has included a section on common “pitfalls” in regional anesthesia and what to do to prevent their occurrence. It focuses on appropriate indications for use of peripheral nerve blocks, utilizing the correct technique and equipment, and rules to follow to avoid complications such as nerve ischemia. Despite the important information contained in this chapter, side effects or complications of peripheral nerve blocks, such as phrenic nerve block, Horner's syndrome, pneumonthorax, and development of block-related neuropathy, are not consistently discussed within the peripheral nerve block chapters. These are important considerations the regional anesthesiologist and patient must be aware of when performing these procedures. While this text provides readers with a concise resource of common peripheral nerve blocks, as the author mentioned in his preface, the text is not a comprehensive collection of all peripheral nerve blocks or all approaches. However, the focused nature of this atlas makes it an easily portable, quick read. Also, although the gross anatomy images contain detailed dissections, they lack sufficient structure identification. Additional labeling of the structures would improve the reader's understanding of the relationship between these structures. Overall, Dr. Boezaart has provided more than just an atlas with his latest publication. This text provides a step-by-step guide to performing peripheral nerve blocks for orthopedic surgery through text, images, and video clips. In addition, this text provides the reader a solid foundation of anatomical knowledge to utilize in selecting peripheral nerve blocks, understanding landmark-based techniques, and avoiding complications. It is an excellent addition to the regional anesthetist's library. Jennifer A. Sposito, MD Resident [email protected] Stuart A. Grant, MD Assistant Professor of Anesthesiology [email protected] Department of Anesthesiology Duke University Durham, North Carolina

Femoral nerve block using ropivacaine 0.025%, 0.05% and 0.1%: effects on the rehabilitation programme following total knee arthroplasty: a pilot study

Femoral nerve blockade is recommended for analgesia following total knee arthroplasty. Following implementation of this type of postoperative analgesia in our hospital we found that active mobilization the day after surgery, may be difficult due to insufficient quadriceps muscle strength. We therefore designed a pilot study comparing the effect of ropivacaine 0.1%, 0.05% or 0.025% on the patient's postoperative rehabilitation and analgesia. Three groups of 12 patients received bolus doses of ropivacaine via their femoral nerve catheters for postoperative analgesia. The ability to actively mobilize, quadriceps muscle strength, pain VAS-scores and patient's satisfaction were measured during in the first three postoperative days. There were no significant differences in the patient's ability to actively mobilize and the pain VAS-scores. The overall satisfaction of the patients with the pain treatment was significantly better (p = 0.049) in the 0.1% compared with the 0.025% group. This pilot-study demonstrated no advantage associated with the use of a ropivacaine concentration less than 0.1%.

Ultrasonography and stimulating perineural catheters for nerve blocks: a review of the evidence

This narrative review summarizes the evidence derived from randomized controlled trials (RCTs) offering blinded assessment and sample size justification, in order to determine the benefits associated with adjunctive ultrasonography (US) and stimulating perineural catheters for nerve blocks. The literature search for this review was conducted during the second week of December 2007 using the MEDLINE (January 1950 to November 2007) and EMBASE (January 1980 to November 2007) databases. For US-guided peripheral and neuraxial blocks, the following medical subject heading (MeSH) terms were searched: "nerve block", "epidural anesthesia", "epidural analgesia", "epidural injection", "epidural space", "spinal anesthesia", and "spinal injection", the results were combined with "ultrasonography" (MeSH term) and "ultrasound" (key word). For stimulating perineural catheters, the following MeSH terms were cross referenced with the MeSH term, "nerve block": "peripheral catheterization", "indwelling catheterization", "catheterization", and keywords, "nerve catheter" and "continuous". Subsequently, the result of this search was combined to "stimulating" (key word). Fifteen RCTs, offering blinded assessment and sample size justification, were retained for analysis. For axillary blocks, US guidance yields a higher success rate than a double-injection, transarterial and a triple-injection, neurostimulation-guided technique. Compared to a quadruple-stimulation technique, no major differences can be found. The addition of nerve stimulation to US guidance offers no clear benefits for axillary blocks. For femoral blocks, compared to neurostimulation, echoguidance is associated with a local anesthetic (LA) sparing effect (up to 42%). In children, US guidance yields a LA sparing effect and a longer duration of action for lower extremity nerve blocks.Compared to their blind counterparts, stimulating catheters seem to offer limited clinical benefits. Despite providing a sparing effect on LA and opioid consumption, stimulating catheters are not associated with a decrease in side effects or analgesia-related expenditures. Published reports of RCTs provide evidence to formulate limited recommendations regarding the use of adjunctive US and stimulating perineural catheters. Further well-designed and meticulously executed RCTs are warranted.

A Novel Approach for Assessing Catheter Position After Ultrasound-Guided Placement of Continuous Interscalene Block

The increasing use of ultrasound has allowed anesthesiologists to perform nerve blocks with a high success rate and without nerve stimulation or eliciting a paresthesia. The ability to visualize peripheral nerve catheters using ultrasound is limited. We present a novel method to confirm the position of an interscalene catheter tip using injection of agitated contrast. The described technique is simple and allows timely assessment of catheter tip position.

Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients

Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients

Évaluation d’une colle liquide pour la fixation des cathéters périnerveux périphériques

Accidental dislodgement of continuous peripheral nerve catheters remains a frequent problem that causes failure of postoperative analgesia. We have assessed the use of new synthetic glue (Mastisol) to secure and maintain catheters in the correct position among 60 patients. This method allowed securing an effective fixation in 94% of cases,resulting in efficient ambulatory orthopedic surgery postoperative analgesia. No nervous or infectious complications were observed. This technique offers a simple, complementary method to secure peripheral nerve catheters.