Long-Term Use of Nerve Block Catheters in Paediatric Patients with Cancer Related Pathologic Fractures

Abstract

SUMMARY We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control.

Ambulatory Continuous Interscalene Blocks for Cancer Pain

“…1,3 Correlations between the duration of catheter placement and risk of infection and inflammation have been found. 4,6 Infections due to the catheter can cause serious complications, including cellulitis, and abscess formation and sepsis.…”

“…Long-term use of continuous peripheral nerve blocks has been suggested to improve pain control and quality of life. 1 Continuous peripheral nerve blocks are used in the management of pain following surgical procedures. Peri-neural catheters are placed using multiple techniques, including ultrasound guidance and nerve stimulation.…”

Prolonged continuous infraclavicular brachial plexus perineural infusion following replantation of a mid-humeral amputation

“…The risk of infection with perineural catheterization is rare, but the incidence is increased with extended duration and infections typically arise from skin flora. 8,18–20 We tunnel each of our catheters subcutaneously as this technique increases the distance from the catheter insertion site to the nerve as well as anchors the catheter in place. While case reports and small series have demonstrated catheters remaining in situ without complication for extended periods (up to 88 days) in select patients, 8,9,21,22 many have shown concern regarding infectious issues with extended catheter duration, and it is unclear as to how long a catheter can safely stay in place for all patients.…”

“…8,18–20 We tunnel each of our catheters subcutaneously as this technique increases the distance from the catheter insertion site to the nerve as well as anchors the catheter in place. While case reports and small series have demonstrated catheters remaining in situ without complication for extended periods (up to 88 days) in select patients, 8,9,21,22 many have shown concern regarding infectious issues with extended catheter duration, and it is unclear as to how long a catheter can safely stay in place for all patients. 7,10,18 Due to this uncertainty, we chose a conservative approach and replaced the infraclavicular catheter approximately once per week to minimize the risk of infectious complications that could have devastating consequences for our patient and his replanted extremity.…”

“…While CPNB has been the common therapy for digital replantation and toe-to-hand transfer, 1,5 description of this technique after traumatic arm amputation and subsequent replantation is limited to short-term catheterization post forearm replantation following a crocodile bite. 6 Descriptions of prolonged use of CPNB (greater than 30 days) is also rare in the literature and linked to treatment of chronic cancer pain 7,8 and PLP. 9 Prolonged brachial plexus perineural infusion has been described in one report of limb salvage in a pediatric patient.…”