Catheter Orifice Configuration Influences the Effectiveness of Continuous Peripheral Nerve Blockade

Abstract

These results suggest that multiorifice catheters provide superior intermittent bolus continuous peripheral nerve blockade compared with end-hole catheters. For anterolateral approach interscalene catheter placement, there is minimal benefit, either way, to 2.5- or 5-cm blind catheter advancement.

Randomized Study of the Effect of Local Anesthetic Volume and Concentration on the Duration of Peripheral Nerve Blockade

“…15 Multimodal oral analgesia consisted of oral acetaminophen 1 g (started 1 h before surgery) and intraoperative intravenously administered parecoxib 0.5 mg/kg to a maximum of 40 mg. A hospital policy change in August 2011 mandated a change in acetaminophen administration from preoperative oral to intaoperative intravenously administered.…”

Ultrasound‐guided femoral catheter placement: a randomised comparison of the in‐plane and out‐of‐plane techniques

“…Advantages of the out‐of‐plane approach include a needle orientation more consistent with the long‐axis of the nerve and adjacent muscle/fascia. Orientation of the needle more in line with the nerve may facilitate catheter advancement in addition to keeping the catheter close to the nerve, and in the case of multi‐orifice catheters, alignment of all orifices alongside the nerve . However, despite theoretical reasons for the superiority of each technique, only one previous randomised controlled trial has been conducted comparing the two approaches .…”

A reply

“…We followed with interest the recent correspondence [1][2][3] regarding an incident of accidental administration of thiopental rather than antibiotics before caesarean section [4]. There appears to be agreement that the largest causative factor in this and other similar incidents is human error.…”

“…The catheter's position can indeed be verified by observing local anaesthetic spread, but we do not do this for the following reasons: firstly, observing local anaesthetic spread via the catheter is technically challenging when using the out-of-plane technique. Secondly, as the catheter is blindly left 3-4 cm beyond a needle tip aligned parallel to the plexus, it simply cannot deviate significantly away from the plexus [4]. Finally, it is uncertain what the operator should do if they can't see local anaesthetic spread; removing such catheters will result in the removal of many appropriately placed catheters.…”

“…Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland [4]. Less than 3 cm increases the risk of subcutaneous placement resulting from movement of the patient's head.…”