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Perineural Catheter (perineural + catheter)

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Medical Sciences	100%

Selected Abstracts

Major complications after 400 continuous popliteal sciatic nerve blocks for post-operative analgesia

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009
V. COMPÈRE
Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post-operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post-operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery. Methods: All popliteal catheters were placed pre-operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th,75th percentiles]. Results: A total of 400 patients were included in the study during a 2-year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale. Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications. [source]

A review of pediatric regional anesthesia practice during a 17-year period in a single institution

PEDIATRIC ANESTHESIA, Issue 9 2007
ALAIN ROCHETTE MD
Summary Background:, There is anecdotal evidence of changes in pediatric regional anesthesia (RA) practice. We performed a retrospective review of prospective data on pediatric RA over 17 years in our institution. Methods:, Data were collected from an electronic database for every anesthetic performed between 1989 and 2005. Type of RA, if any, and age of the patient were noted. Patients were divided into two groups: ,4 years (younger group) and 5 years or older (older group). Results:, A total of 51 408 anesthetics were performed; 23 609 (46%) in the younger group. A total of 10 929 RA were performed. In the younger group, RA increased from 9.5% to 27.6% (P < 0.001). Neuraxial blocks decreased from 100% to 59.7% of RA. Caudals decreased in the late 1990s from 70% to 22% of RA and epidurals have decreased from 22% to 11% of RA since 2002. Neonatal spinals were introduced in 1990 and now reach 30% of RA. Peripheral blocks have increased up to 37% of RA since 1994. In the older group, RA increased from 9.2% to 23.3% (P < 0.001), less than in the younger (P < 0.01). Neuraxial blocks have decreased from 97% to 24.9% of RA (P < 0.001), more obviously than in the younger group (P < 0.001). Peripheral blocks emerged in 1994, outnumbering neuraxial blocks as early as 1995 and now account for 75% of RA. This increase is significantly more pronounced than in the younger group (P < 0.001). In both groups, peripheral blocks were distributed among plexus blocks (30%) and compartment/peripheral nerve blocks (70%). In the last 5 years, a perineural catheter was placed in 12.9% of peripheral blocks to ensure continuous postoperative analgesia. Conclusions:, In our hospital, there has been a dramatic increase in RA, mainly from 1989 to 1995. The most remarkable events in the last decade were: (i) the change in practice from neuraxial to peripheral blocks and (ii) the emergence of continuous postoperative analgesia via perineural catheters. [source]

Stimulating or conventional perineural catheters after hallux valgus repair: a double-blind, pharmaco-economic evaluation

ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 10 2006
A. Casati
Background:, We prospectively evaluated direct analgesia-related costs of continuous sciatic nerve block using either a stimulating or conventional catheter after hallux valgus repair. Methods:, The perineural catheter was inserted through a stimulating introducer either blindly (group Conventional, n= 38) or while stimulating via the catheter (group Stimulating, n= 38). Nerve block was induced with 25 ml of mepivacaine 15 mg/ml, and was followed 3 h later by a patient-controlled infusion of ropivacaine 2 mg/ml (basal infusion: 3 ml/h; incremental dose: 5 ml; lock-out time: 30 min). Rescue tramadol [100 mg intravenous (i.v.)] was given if required. Local anesthetic consumption, need for rescue tramadol and post-operative nausea and vomiting (PONV) treatment, and patient's satisfaction were recorded during first 24-h infusion. Cost calculations were based on the acquisition cost of drugs and devices. Results:, Both techniques were similarly effective, but local anesthetic consumption and need for rescue analgesics were lower in the Stimulating group [respectively, 120 vs. 153 ml (P= 0.004) and 21% vs. 60% (P= 0.001)]. The analgesia-related costs for 24 h were similar when 100-ml bags of ropivacaine 2 mg/ml were used (66 , vs. 67 ,; P= 0.26). When 200-ml bags of ropivacaine were used, the analgesia-related costs were higher in the Stimulating group than the Conventional group (75 , vs. 55 ,; P= 0.0005). Conclusions:, Direct costs of continuous sciatic nerve block ranged from 55 to 75 ,. Stimulating catheters reduced local anesthetic consumption and need for rescue analgesics. This was only cost effective when 100-ml bags of 2 mg/ml ropivacaine were used, while the cheapest combination was the use of conventional catheters and 200-ml bags of ropivacaine. [source]