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Background and Aims Continuous peripheral nerve blocks remain the minority technique included in ERAS protocols to decrease opioid requirements. One common deterrent to the placement of continuous modalities are cost and questionable longevity of these blocks due to leaking and migration. The current literature is lacking in the incidence of leaking especially among obese patient populations. One prevailing thought is the method in which these catheters are placed is flawed: by inserting the catheter through the needle, the diameter differences between the catheter and puncture site contributes to its leaking versus over the needle. The aim of this study is to evaluate the rate of leaking without BMI restrictions comparing over the needle to through the needle catheters in highly mobile lower extremity blocks.
Methods Retrospective chart review of 79 patients that received a continuous popliteal nerve block without exclusions to BMI utilizing either the Pajunk-E cath echogenic the over the needle (CON) or Halyard T-Block continuous echogenic through the needle(CTN) techniques as part of their ERAS care.
Results Subjects that received CON catheters experienced a reduced rate (average 11.1%) of leaking as compared to the CTN group with (38.46%) with a p- value of 0.018. The impact of BMI resulted with a higher rate of leaking in the CTN of 80% and CON had 14.3% with a p-value of 0.015.
Conclusions The reduction of leaking noted lower extremity continuous peripheral nerve blocks in obese patients can be reduced by utilizing an over the needle system. This prolongation could prevent opioid related complications and enhance rehabilitation.
Attachment PH-21-017 Approval Letter.pdf