Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients

Abstract

In this large series of outpatients treated with CPNB, there were surprisingly few interventions requiring an anesthesiologist. Likewise, patients were able to manage and remove their catheters at home without additional follow-up. This suggests that with adequate instruction and telephone access to health care providers, patients are comfortable with managing and removing CPNB catheters at home.

Does continuous interscalene nerve blockage delay discharge following minimal invasive shoulder surgery?

“…Several centers in different countries have published on the results of ambulatory interscalene infusions associated with earlier (within 24 hours) discharge from the hospital [1,2] . In Fredrikson's series discharge occurred within the 24 hours "unless prevented by social circumstances" and similarly in our group several patients chose to remain in hospital for reasons other than superior pain control management.…”

“…These fairly innocent, but potentially worrying problems were all dealt with by nursing staff on the ward, all of whom had been appropriately educated and had a comprehensive protocol for guidance. Other studies have dealt with these problems over the phone or by reviewing the patient back in the hospital for re-establishment of block or intravenous narcotics following catheter dislodgement [1,2] . Although these events seem rare they can be inconvenient to an anesthetist at a remote location particularly after hours.…”

“…Recent studies have proven the safety and efficacy of same day surgery (SDS) with continuous peripheral nerve blockade [1] including patients who have had arthroscopic shoulder surgery [2,3] . Success for the practice of discharge home with a perineural infusion in situ has been achieved with a high degree of organization, incorporating extensive patient education and post operative review either by telephone or a direct out of hospital visit.…”

“…Success for the practice of discharge home with a perineural infusion in situ has been achieved with a high degree of organization, incorporating extensive patient education and post operative review either by telephone or a direct out of hospital visit. Rarely patients have required return to hospital to reestablish a block or admission [1] . However, the real possibility exists that the duration of blockade may exceed the presence of pain for some patients as this can be extremely variable between patients.…”

Knotting of a Perineural Catheter Inserted with Ultrasonography

“…This has led many authors to advocate using ultrasonography for continuous nerve blocks as well. 11,12 One commonly used method, described by Swenson et al 13 consists in visualising the target nerve in short axis. Under direct vision, the needle is advanced toward the latter.…”