Comparison of catheter tip migration using flexible and stimulating catheters inserted into the adductor canal in a cadaver model

Abstract

Use of adductor canal blocks and catheters for perioperative pain management following total knee arthroplasty is becoming increasingly common. However, the optimal equipment, timing of catheter insertion, and catheter dislodgement rate remain unknown. A previous study has suggested, but not proven, that non-tunneled stimulating catheters may be at increased risk for catheter migration and dislodgement after knee manipulation. We designed this follow-up study to directly compare tip migration of two catheter types after knee range of motion exercises. In a male unembalmed human cadaver, 30 catheter insertion trials were randomly assigned to one of two catheter types: flexible or stimulating. All catheters were inserted using an ultrasound-guided short-axis in-plane technique. Intraoperative knee manipulation similar to that performed during surgery was simulated by five sequential range of motion exercises. A blinded regional anesthesiologist performed caliper measurements on the ultrasound images before and after exercise. Changes in catheter tip to nerve distance (p = 0.547) and catheter length within the adductor canal (p = 0.498) were not different between groups. Therefore, catheter type may not affect the risk of catheter tip migration when placed prior to knee arthroplasty.

Randomized comparison of popliteal-sciatic perineural catheter tip migration and dislocation in a cadaver model using two catheter designs

“…The effects of limb manipulation on catheter migration may differ between cadaver models and living human subjects because of differences in tissue mechanics [ 26 ]. However, the use of cadaver models has been described previously in studies of perineural catheter migration [ 8 27 ] and has the following advantages: 1) standardization of the catheter procedure and ROM intervention, which is not possible across human subjects, and 2) the ability to alter the flexible epidural catheter to enhance echogenicity [ 8 27 ], which occludes the distal orifice and prevents its clinical use for perineural infusion. Due to this modification, fluid was not administered via the catheters; thus, our study was unable to assess leakage.…”

A comparison of strength for two continuous peripheral nerve block catheter dressings

“…Additionally, the study tested dressing strength by using a weight sufficient to disrupt the integrity of the dressing but not cause actual catheter dislocation or dislodgement. Previous studies have investigated catheter migration and dislocation in a simulation setting by using cadavers and volunteers [ 3 8 9 ], but the present study is the first to rigorously compare perineural catheter dressing and securement methods.…”