Postoperative pain after certain surgeries is effectively controlled by the application of peripheral nerve blocks via catheters, which can provide longer lasting relief. This technique is increasingly used as a component of multimodal analgesia. However, peripheral nerve catheterization requires skill, effort, and funds – and must be carried out according to well-researched protocols.
A peripheral nerve block pauses pain signals from a specific area of the body. Patients receiving a peripheral nerve block, compared to those receiving intravenous opioids, tend to experience better pain control and a reduced need for additional opioids across a variety of upper and lower extremity surgical procedures.
Operationally, catheters have to be placed in the correct anatomical position and meticulously maintained as long as they remain in situ. For example, in patients with surgery of upper and lower limbs, common locations for peripheral catheters include the interscalene, femoral, and sciatic positions. In contrast, in abdominal and thoracic surgery, birth pain, and artery occlusive disease, epidural catheters are effective [1].
Risks of peripheral nerve blocks, irrespective of technique or block location, include vascular puncture and bleeding, nerve damage, and local anesthetic systemic toxicity. Site-specific complications include quadriceps weakness in patients receiving a femoral nerve block, as well as pleural puncture or neuraxial blockade in patients receiving an interscalene block. Other potential complications, although rare, may include a local infection or inflammation at the catheter site.
A peripheral nerve block may be administered as a single injection (sPNB) or continuous infusion via a perineural catheter (cPNB). In contrast to a cPNB, a sPNB is usually limited to 12-24 hours in duration of action.
In general, a cPNB has been associated with a reduced time to discharge, including in pediatric patient populations [2]. However, a cPNB may be complicated by a catheter obstruction, migration, or accidental removal, as well as any leakage of local anesthetic. Furthermore, ambulatory cPNB must come with appropriate patient selection, education, and a fully available health care provider to swiftly address any complications [3].
In patients who undergo certain surgical procedures, such as orthopedic interventions, the surgeon may recommend that the patients wear take-home peripheral nerve block catheters to help manage their postoperative pain [4]. This will depend on a variety of factors, including the type of surgery and whether a patient has access to at-home support. These devices may help patients leave the hospital more rapidly, reduce the amount of opioids required, and accelerate a patient’s full recovery of movement and function.
The ideal peripheral nerve block technique should have a duration of action that is sufficiently long to address the most intense period of postoperative pain, should incur a minimal risk of infection, and should be associated with few neurologic complications, bleeding, or local anesthetic systemic toxicity. It should also ideally be convenient and easy to perform and manage postoperatively.
Many reports to date lack a comprehensive description of catheter application, management, failure rates and complications. As a result, methods are still not consistent across clinical settings, despite more than half of surgical patients still suffering from varying degrees of postoperative pain. In the future, additional research is thus clearly warranted in order to further develop the safest and most efficacious peripheral nerve block possible.
References
- Suksompong, S., von Bormann, S. & von Bormann, B. Regional catheters for postoperative pain control: Review and observational data. Anesthesiology and Pain Medicine (2020). doi:10.5812/aapm.99745
- Simić, D. et al. The safety and efficacy of the continuous peripheral nerve block in postoperative analgesia of pediatric patients. Frontiers in Medicine (2018). doi:10.3389/fmed.2018.00057
- Joshi, G., Gandhi, K., Shah, N., Gadsden, J. & Corman, S. L. Peripheral nerve blocks in the management of postoperative pain: challenges and opportunities. Journal of Clinical Anesthesia (2016). doi:10.1016/j.jclinane.2016.08.041
- Nerve Block Catheter: Improving Pain Relief After Surgery | HSS. Available at: https://www.hss.edu/conditions_take-home-nerve-block-catheter.asp. (Accessed: 29th September 2022)
