We’re setting up continuous regional anesthesia catheters in our hospital. It hasn’t been easy, but I’ve learned a lot along the way.
2018, Pages 135-140.e2
Update on Continuous peripheral nerve block techniques
- Arrow, StimuCath continuous, nerve block procedural kit ASK 05060-cch 19 Ga, 60 cm catheter, insulated needle, 18 g 3.81 inch
- The catheter was advanced 3–5 cm beyond the needle tip. During supraclavicular catheter insertion, the catheters were placed dorsolateral to the nerve plexus.
- During popliteal catheter insertion, the catheters were placed next to the nerve with the needle coming from the lateral side of the thigh. The catheter was advanced 3–5 cm beyond the tip of the needle to end within the space between the semitendinosus and semimembranosus muscles medially and biceps femoris muscle laterally.
- AmbIT pump (Summit Medical Production, Inc., Salt Lake city, UT, USA)
- After catheter placement, an initial bolus dose of 20 mL ropivacaine 0.75% was administered. All patients were evaluated for sensory and motor block prior to surgery. Before discharge, the catheters were connected to AmbIT pumps infusing ropivacaine 0.2% with an 8 mL/hour basal rate and a 12 mL demand dose once per hour.
- On the fifth day, patients were instructed to stop the infusion for 6 hours and then remove the catheter if their pain scores were less than 5 and well tolerated by the patients. If pain was more than or equal to 5 we asked patients to restart their infusions and we did the same every day until the catheter was removed.
- The results of study demonstrate that the prolonged use of ambulatory catheters for a period up to 5 days did not lead to an increased incidence of complications as compared to other studies. Main complications were minor infections and pharmacological symptoms, which resolved with catheter removal and without the need for additional medical intervention.
- epidural catheter (Perifix® Complete Set, B-Braun, Germany)
- LA solution (a 1:1:1 mixture of 30 mL of 0.5% bupivacaine, 2% lidocaine, and 0.9% saline)
- Block placed about 3 cm lateral to T spine
- Rescue dose of LA mixture (15 mL of 0.5% bupivacaine and 15 mL of 0.9% saline) was injected through the catheter.
- In addition, we used a 30 ml volume of LA, and we believe that plane blocks, such as ESP, need more volume, and that these blocks are volume dependent.
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