Stimulating Popliteal Catheters for Postoperative Analgesia After Hallux Valgus Repair

Abstract

Stimulating catheters have been recently introduced in clinical practice. We assessed the efficacy of stimulating and nonstimulating catheter placement for pain control and local anesthetic requirements after hallux valgus repair with continuous sciatic popliteal nerve block in this comparative, randomized, blinded-to-observer study of 48 patients. A stimulating catheter was placed in groups S-125 and S-0625. The same catheter was inserted without stimulation in group NS-125. An infusion of 0.125% levobupivacaine was given in groups S-125 and NS-125, whereas 0.0625% levobupivacaine was used in group S-0625. All patients received an infusion of the test drug at a basal rate of 3 mL/h, with the possibility of an additional bolus of 3 mL every hour. Verbal analog scale (VAS) scores for pain were assessed between 6-8 h and between 19-23 h postoperatively. Multiple attempts were required for catheter insertion in all patients in groups S-125 and S-0625. Lower median (range) VAS scores for pain (0-100 points) were found in group S-125 at 6-8 h postoperatively when compared with groups S-0625 and NS-125: 5 (0-17.5) versus 60 (15-80) and 70 (25-80), respectively (P < 0.05); and lower VAS scores for pain were also found in group S-125 at 19-23 h when compared with group NS-125: 0 (0-0) and 7.5 (0-10), respectively (P < 0.05). Fewer patients required IV opioid analgesia in group S-125 than in groups S-0625 and NS-125: 0, 5, and 7 patients, respectively (P < 0.05). We conclude that efficacy in pain control was increased with stimulating catheter placement.

Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery

“…local anesthetic and systemic opioid use [13][14][15]. Thus, use of stimulating catheters may change findings.…”

The Effect of Stimulating Versus Nonstimulating Catheter Techniques for Continuous Regional Anesthesia

“…14 To evaluate an overall effect of catheter choice despite the different modes to administer rescue medication, we calculated the percentage difference between the 2 study groups in each single study (Table 1). In case of 2 or more investigated rescue analgesics within the same trial, 2,12,13,15,16 we calculated the resulting average value. In 1 trial with 3 study groups, 16 we considered only the stimulating-catheter group using the same concentration of L-bupivacaine as the control group.…”

“…In case of 2 or more investigated rescue analgesics within the same trial, 2,12,13,15,16 we calculated the resulting average value. In 1 trial with 3 study groups, 16 we considered only the stimulating-catheter group using the same concentration of L-bupivacaine as the control group. All trials reporting rescue medication showed a better analgesic action associated with stimulating catheters in the intraoperative and postoperative phase, although the difference in some trials was rather negligible.…”

Ultrasonography and stimulating perineural catheters for nerve blocks: a review of the evidence

“…RCTs have used alternately different kits: the Arrow StimuCath Continuous Nerve Block Set (Arrow international, Reading, PA, USA); [23][24][25]27 an 18G, 85-mm long needle, oversheathed with a plastic introducer set (Multiplex, Vygon, France); 28,29 a 50-mm, 18G needle with a stimulating catheter (Polymedic C-50 K +); 26 or a 22G, stimulating catheter with a 19.5G, 100-mm needle set (Stimulong Plus, Pajunk, Geisingen, Germany). 30 Further studies are required to compare the electrical properties of these kits.…”

“…Rodriguez et al 30 randomized 48 patients to blind catheters using levobupivacaine 0.125% infusion, stimulating catheters using levobupivacaine 0.0625% infusion (median stimulatory threshold of the catheter = 0.52 mA; pulse width = 0.1 msec), and stimulating catheters using levobupivacaine 0.125% infusion (median stimulatory threshold of the catheter = 0.42 mA; pulse width = 0.1 msec). All infusions were run at a basal rate of 3 mL·hr -1 , with the possibility of one additional bolus of 3 mL every hour.…”