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Continuous Peripheral Nerve Block for Ambulatory Surgery
  1. Stuart A. Grant, M.B., Ch.B., F.R.C.A.,
  2. Karen C. Nielsen, M.D.,
  3. Roy A. Greengrass, M.D.,
  4. Susan M. Steele, M.D. and
  5. Stephen M. Klein, M.D.
  1. From the Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
  1. Reprint requests: Stuart Grant, M.B., Ch.B., F.R.C.A., Glasgow University Department of Anaesthetics, Glasgow Royal Infirmary, 10 Alexandra Parade, Glasgow G31 2ER, UK.

Abstract

Background and Objectives Continuous peripheral nerve block (CPNB) can provide surgical anesthesia, prolonged postoperative analgesia, and acceptable side effects. Despite these advantages, CPNB is not in widespread use. Recently a new CPNB catheter system (Contiplex, B. Braun, Bethlehem, PA) was developed based on an insulated Tuohy needle, which allows for injection of local anesthetic and catheter insertion without disconnection or needle movement. At present, no clinical studies exist describing this system.

Methods Data were prospectively gathered for 1 year from 228 patients in an ambulatory surgery center. All CPNB were performed using the Contiplex system to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for loss of sensation. Patients were then discharged.

Results Initial peripheral block was successful in 94% of patients. Failed nerve block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of patients at 24 hours, and 8% of patients required more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit (PACU), only 4 patients (1.7%) required treatment for nausea. At 24 hours and 7 days postsurgery, no patient reported a dysesthesia.

Conclusions CPNB using the insulated Tuohy catheter system offered acceptable anesthesia and prolonged pain relief postsurgery. There were few side effects.

  • Continuous peripheral nerve block
  • Ropivacaine
  • Ambulatory surgery

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Footnotes

  • Drs. Steele and Greengrass hold the patent on the contiplex system used. The needles used were all supplied at no cost by B. Braun Medical.