Prolonged Catheter Use and Infection in Regional Anesthesia

Abstract

Background Prolonged catheter use is controversial because of the risk of catheter-related infection, but the extent to which the risk increases over time remains unknown. We thus assessed the time-dependence of catheter-related infection risk up to 15 days. Methods Our analysis was based on the German Network for Regional Anesthesia, which includes 25 centers. We considered 44,555 patients who had surgery between 2007 and 2014 and had continuous regional anesthesia as well as complete covariable details. Cox regression analysis was performed and adjusted for confounding covariables to examine the relationship between catheter duration and probability of infection-free catheter use. Results After adjustment for confounding factors, the probability of infection-free catheter use decreases with each day of peripheral and epidural catheter use. In peripheral catheters, it was 99% at day 4 of catheter duration, 96% at day 7, and 73% at day 15. In epidural catheters, it was 99% at day 4 of catheter duration, 95% at day 7, and 73% at day 15. Only 31 patients (0.07%) had severe infections that prompted surgical intervention. Among these were five catheters that initially had only mild or moderate signs of infection and were left in situ; all progressed to severe infections. Conclusions Infection risk in catheter use increases over time, especially after four days. Infected catheters should be removed as soon as practical.

A review of peripheral nerve blocks for cesarean delivery analgesia

“…Single-shot wound infiltration may provide adequate analgesia, but effectiveness is limited by the pharmacokinetic properties of the selected drug, making prolonged analgesia less reliable. CWI allows continuous administration of local anesthetic with or without non-steroidal anti-inflammatory drugs throughout the postpartum period for up to 4 days 52. As with any indwelling catheter, risks for infection and catheter migration can occur.…”

Incidence of infection in non‐tunnelled thoracic epidural catheters after major abdominal surgery

“…Bomberg et al reported the incidence of catheter‐associated infection as 1% after catheter use for 4 days, but a significant increase to 5% after 7 days. Furthermore, progression of the infection from mild to moderate was evident within 1.7 days if the catheter was not removed immediately 22 . In our study, most epidural catheters were removed on the fifth day and as soon as possible if signs of infection were observed.…”

Epidural Analgesia to Facilitate Breastfeeding in a Grand Multipara

“…The risk of using PCEA is extremely low. Infection, for example, is essentially a nonissue if the catheter is maintained in situ for 4 days or fewer (Bomberg et al, 2018). In our case, because our parturient was so pleased with her lack of pain, she elected to keep the PCEA in place until a few hours prior to discharge home.…”