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ESRA19-0133 Continuous peripheral nerve blocks (CPNB) for pain management and wound care at a surgery ward – two success clinical cases
  1. J Carreteiro,
  2. S Moreira and
  3. R Silva
  1. Centro Hospitalar de Lisboa Ocidental, Anaesthesiology, Lisbon, Portugal


Background and aims CPNB are achieved by infusion or intermittent boluses of local anesthetic solutions. We present two cases showing their benefits in in-patients on a surgery ward.

Case A: 82-year-old female, ASA III, presenting with painful external malleolus ulcer requiring transdermal fentanyl for pain control but with excessive somnolence and bradypnea.

Case B: 44-year-old male, ASA I, painful hand cellulitis previously submitted to surgical cleaning and debridement, requiring daily wound care, needing opioid analgesia.

Methods We performed a continuous ultrasound-guided popliteal sciatic block in Case A and a continuous ultrasound-guided costoclavicular block in Case B. Both blocks were performed with Vygon Silverstim® continuous peripheral catheter set, using an in-plane approach and ultrasound GE Venue 40® with a 12Hz linear probe. Follow-up was maintained throughout hospitalization. In both cases, catheter was maintained while under antibiotic therapy.

Results Case A: Ropivacaine 0.2% 20 ml was delivered through the catheter and a Ropivacaine 0.2% 4.1 mL/h infusion was maintained over 21 days.

Case B: Ropivacaine 0.375% 15 ml was delivered through the catheter and a Ropivacaine 0.1% 4.1 mL/h infusion was maintained over 16 days.

Both patients successfully underwent daily wound management, without opioid analgesia, displaying low pain scores and allowing for physical rehabilitation. Additionally, minimal sensory, motor, and proprioception deficits were noticed. No local anesthetic toxicity or infection was reported.

Conclusions CPNB provide a safe and effective approach for pain management. In both cases it allowed for daily wound care daily, reducing opioid requirement, minimizing adverse effects as well as allowing for early mobilization and efficient rehabilitation.

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