Is There Any Need for Expanding the Perineural Space Before Catheter Placement in Continuous Femoral Nerve Blocks?

Dang, Charles Pham; Guilley, Jérôme; Dernis, Lyndia; Langlois, Cécile; Lambert, Chantal; Nguyen, Jean–Michel; Pinaud, M.

doi:10.1016/j.rapm.2006.05.012

Cited by 10 publications

(2 citation statements)

References 22 publications

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“…Catheter threading in the interscalene area can be challenging [75]. Expanding the perineural space with injectate has been shown to facilitate catheter advancement [80]. Local anaesthetic, normal saline and dextrose 5% have all been used, but dextrose has advantages over both saline and local anaesthetic because an evoked muscle response is typically maintained after injection through the stimulating needle [81].…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques

2010

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SummaryShoulder surgery is well recognised as having the potential to cause severe postoperative pain. The aim of this review is to assess critically the evidence relating to the effectiveness of regional anaesthesia techniques commonly used for postoperative analgesia following shoulder surgery. Subacromial ⁄ intra-articular local anaesthetic infiltration appears to perform only marginally better than placebo, and because the technique has been associated with catastrophic chondrolysis, it can no longer be recommended. All single injection nerve blocks are limited by a short effective duration. Suprascapular nerve block reduces postoperative pain and opioid consumption following arthroscopic surgery, but provides inferior analgesia compared with single injection interscalene block. Continuous interscalene block incorporating a basal local anaesthetic infusion and patient controlled boluses is the most effective analgesic technique following both major and minor shoulder surgery. However, interscalene nerve block is an invasive procedure with potentially serious complications and should therefore only be performed by practitioners with appropriate experience.

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Section: Discussionmentioning

confidence: 99%

Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques

2010

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“…Injection of 0.9% saline solution to facilitate catheter placement is frequently performed, however, no report has described the use of a saline injection to facilitate the removal of a knotted catheter 6. We report a case of successful removal of a knotted stimulating femoral nerve catheter after saline expansion of the catheter pocket at the bedside.…”

Section: Introductionmentioning

confidence: 99%

Removal of a knotted stimulating femoral nerve catheter using a saline bolus injection

Kendall

Nader²,

Maniker³

et al. 2010

LRA

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ObjectiveStimulating peripheral nerve catheters have become increasingly popular as part of postoperative multimodal analgesia for total knee arthroplasty. We describe a case of a successful nonsurgical removal of a knotted stimulating femoral nerve catheter after saline expansion of the catheter pocket at the bedside.Case reportA 65-year-old female underwent total knee arthroplasty under combined spinal epidural anesthesia. Postoperatively, a stimulating femoral nerve catheter was placed without complication. The catheter was threaded 12 cm past the needle tip with minimal resistance. Function of the catheter was verified by loss of pinprick sensation in the femoral nerve distribution and excellent analgesic efficacy was achieved. The first attempt at catheter removal was unsuccessful. Thigh flexion and rotation also failed to facilitate catheter removal. The catheter was then left to continuous tension for 6 hours, but further attempts at removal remained unsuccessful. Under ultrasound visualization, 10 mL of saline was injected through the catheter with moderate resistance and without patient discomfort, after which the catheter was removed using minimal tension. The catheter was intact but had a single knot at the distal end of the catheter.ConclusionsWe present a rare case of a knotted stimulating catheter in which the use of a saline bolus to dilate the catheter pocket proved to be successful after other simple methods of catheter removal had failed. Given the simple nature of this technique, it can be attempted at the bedside before more invasive procedures are planned.

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Lower Extremity Blocks: Femoral Nerve Block and Adductor Canal Block

Khan

Ahmad

2022

Anesthesiology in-Training Exam Review

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Is There Any Need for Expanding the Perineural Space Before Catheter Placement in Continuous Femoral Nerve Blocks?

Abstract: Expansion of the perineural space with D5W is useful for catheter placement in continuous femoral nerve block.

Cited by 10 publications

References 22 publications

Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques

Postoperative analgesia for shoulder surgery: a critical appraisal and review of current techniques

Removal of a knotted stimulating femoral nerve catheter using a saline bolus injection

Lower Extremity Blocks: Femoral Nerve Block and Adductor Canal Block

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