Inflammation and infection complications in 2285 perineural catheters: a prospective study

Abstract

Background: Perineural catheters (PNC) are increasingly used for postoperative analgesia in orthopedic surgery. There are only few large studies looking at complications associated with regional anesthesia and the literature has mainly focused on neurologic damage, hemodynamic and cardiac events Although infection is a major issue, particularly for surgery with implantation of prosthetic material, data dealing with local inflammation and infection of PNC are still rare.Objective: The incidence, severity and localization of local inflammation and infection following the placement of various PNC were prospectively assessed. Methods:After approval from the local ethical committee and written informed consent, all PNC placed under sterile conditions for regional anesthesia and postoperative analgesia were prospectively evaluated. Local inflammation was defined as redness, swelling or pain on pressure at the catheter insertion site. Infection was defined as pus at the catheter insertion site with or without the necessity for surgical intervention. Descriptive statistics were performed and pϽ0.05 was considered significant.Results: 2285 PNC were evaluated over 24 months: 600 axillary, 303 interscalene, 92 infraclavicular, 65 psoas compartment, 574 femoral, 296 sciatic and 355 popliteal. Local inflammation occurred in 4.2% and infection in 3.2%. Surgical intervention was necessary in 0.9%. Duration of PNC was a risk factor. No late complication occurred in any patient. Interscalene catheters were associated with an increased risk of infection (4.3%). Anterior proximal sciatic catheters were associated with a lower risk of local inflammation (1.7%) and infection (0.4%). Staphylococcus epidermidis and staphylococcus aureus were isolated in 42% and 58% respectively. Conclusion:Infection of PNC is a rare occurrence but the incidence varies with the PNC localization and increases with duration. Close clinical monitoring is required.