by Nicole Berardoni M.D., Paul Lynch M.D., and Tory McJunkin M.D.
Although there are common conditions where continuous catheter blocks are used, they are most often used in the treatment of:
- Back and neck pain
- Traumatic nerve injuries
- Peripheral vascular disease neuropathy
- Post-amputation pain
- Herpetic neuralgia
- Trigeminal neuralgia
- Brachial plexus neuropathies
Continuous Catheter Nerve Blocks ProcedureThe placement of catheters typically takes less than 15 minutes and is done in a way to minimize complications. Your physician will first cleanse the skin and may provide IV sedation. Then local anesthetic is placed into your skin, and a needle is placed through the anesthetized tissue. Using nerve stimulation with twitch-monitor or ultrasound guidance your physician will place the needle next to the desired nerve. Then the catheter is advanced through the needle into the correct location. The needle is then withdrawn and the catheter remains in place. Your physician will adhere the catheter to the skin using a bandage and liquid adhesive to ensure the catheter will not dislodge. A small container holding the medication, typically the size of a softball, is attached to the catheter and kept in a carrying pouch. This will provide a constant stream of a local anesthetic and other medications to the source of pain. Your physician will then most likely remove the catheter in five to seven days following placement.
Continuous Catheter Nerve Blocks Benefits
In all of these investigations, patients who received continuous infusion local anesthetic achieved significantly lower resting and breakthrough pain when compared with those using exclusively oral opioids (morphine) for their pain management. In addition, they required a significantly lower amount of oral pain medications to control their pain (Ilfeld 2005). By decreasing the amount of oral pain medication, you will be decreasing the side effects opioids typically have on people (including drowsiness and constipation). If the affected nerves are irritated, a continuous infusion may calm down irritated nerves and provide prolonged pain relief.
Continuous Catheter Nerve Blocks RisksMost continuous catheter nerve blocks are performed on an outpatient basis with minimal risks. However, as expected with any procedure, there are associated risks. In this particular procedure the risks are bleeding, infection, inadequate pain surface area coverage, and nerve injury (Ilfeld 2007). While the catheter site is healing it is important to keep it dry and clean so an infection does not occur. If there is any drainage or redness at the site, then you may have developed an infection, and your pain specialist must evaluate you.
Continuous Catheter Nerve Blocks Outcome
In 2006, a study was performed in patients after knee surgery. When compared with a control group of patients only using intravenous opiates following the surgery, the group of patients who received continuous catheter infusion of ropivacaine (local anesthetic) provided better analgesia, increased rehabilitation, and a shorter hospital length of stay (Ruyter 2006).
In a large study of pediatric patients with complex regional pain syndrome, continuous peripheral nerve blocks were placed for recurrent complex regional pain syndrome. The authors concluded that the peripheral infusion catheters offer significant and novel contribution to treat recurrent pediatric complex regional pain syndrome, by allowing complete pain relief, early mobilization, and rapid return home, therefore representing a psychological advantage for these children (Dadure 2005). After years of research in many different conditions and pain treatment options, it was concluded that continuous catheter infusion are associated with less side effects and appears to offer better pain control than intravenous patient-controlled analgesia with morphine and continuous epidural analgesia (Singelyn 2005).
- Ambulatory Perineural Local Anesthetic Infusion. Ilfeld, Brian; University of Florida, Gainesville. 4th Regional Anesthesia Int’l Symposium Oct. 11, 2002
- Continuous Peripheral Nerve Blocks for Patients at Home Brian M. Ilfeld, M.D. F. Kayser Enneking, M.D. American Society of Anesthesiologists May 2005
- A pilot study on continuous femoral perineural catheter for analgesia after total knee arthroplasty: the effect on physical rehabilitation and outcomes. De Ruyter ML, Brueilly KE, Harrison BA, Greengrass RA, Putzke JD, Brodersen MP. J Arthroplasty. 2006 Dec;21(8):1111- 7. Epub 2006 Jun 21
- Continuous peripheral nerve blocks at home for treatment of recurrent complex regional pain syndrome I in children. Dadure C, Motais F, Ricard C, Raux O, Troncin R, Capdevila X. Anesthesiology. 2005 Feb;102(2):252-5.
- Effects of intravenous patient-controlled analgesia with morphine, continuous epidural analgesia, and continuous femoral nerve sheath block on rehabilitation after unilateral total-hip arthroplasty. Singelyn FJ, Ferrant T, Malisse MF, Joris D. Reg Anesth Pain Med. 2005 Sep-Oct;30(5):452