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BRIEF TECHNICAL REPORT
Wound Spread of Radiolabeled Saline With Multi- Versus Few-Hole Catheters
  1. Lasse Ø. Andersen, MD*,†,
  2. Billy B. Kristensen, MD*,†,
  3. Jan L. Madsen, MD, PhD*,‡,
  4. Kristian S. Otte, MD*,§,
  5. Henrik Husted, MD*,§ and
  6. Henrik Kehlet, MD, PhD*,∥
  1. From the *The Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Departments of
  2. †Anesthesiology,
  3. ‡Clinical Physiology and Nuclear Medicine, and
  4. §Orthopedic Surgery, Hvidovre Hospital; and
  5. ∥Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
  1. Address correspondence to: Lasse Ø. Andersen, MD, Lundbeck Centre for Fast-track Hip and Knee Arthroplasty, Hvidovre Hospital, Kettegård Allé 30, DK-2650 Hvidovre, Denmark (e-mail: lasseandersen{at}email.dk).

Abstract

Background and Objectives: Continuous wound infusion of local anesthetics is effective in postoperative pain management and may be useful in major joint arthroplasty, but the optimal technique for postoperative administration of local anesthetics in the wound awaits trials evaluating the optimal type of catheter (single-, few-, or multiholed catheters).

Methods: Sixteen patients undergoing total hip arthroplasty were randomized to intraoperative subfascial placement of a triple-orifice epidural catheter or a 15-cm multiholed catheter. Twenty milliliters of technetium Tc 99m diethylenetriaminepentaacetic acid-labeled saline was injected postoperatively and wound spread for 10 mins was recorded with a double-head gamma camera.

Results: Mean (SD) wound spread (cm2) was the same with administration through a multiholed catheter versus the epidural catheter in both anterior (89 [15] versus 82 [20], P = 0.4) and lateral (68 [19] versus 60 [11], P = 0.3) projections.

Conclusions: Wound spread of a bolus injection through 15-cm multiholed catheters versus triple-orifice epidural catheters is similar with subfascial catheter placement in total hip arthroplasty. Procedure-specific trials are required to evaluate the analgesic efficacy of postoperative administration of local anesthetic in the wound with different types of catheter before general recommendations can be made.

https://doi.org/10.1097/AAP.0b013e3181c7733d

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    Footnotes

    • The study was supported by The Lundbeck Foundation and IMK Almene Fond, Copenhagen, Denmark.

    • H.K. and B.K. have received an unrestricted research grant from AstraZeneca, Södertälje, Sweden, and Baxter, Inc, Europe for studying local infiltration analgesia.