Misplacement of a psoas compartment catheter in the subarachnoid space

A continuous peripheral nerve block (cPNB) is provided in the hospital and ambulatory setting. The most common use of CPNBs is in the peri- and postoperative period but different indications have been described like the treatment of chronic pain such as cancer-induced pain, complex regional pain syndrome or phantom limb pain. The documented benefits strongly depend on the analgesia quality and include decreasing baseline/dynamic pain, reducing additional analgesic requirements, decrease of postoperative joint inflammation and inflammatory markers, sleep disturbances and opioid-related side effects, increase of patient satisfaction and ambulation/functioning improvement, an accelerated resumption of passive joint range-of-motion, reducing time until discharge readiness, decrease in blood loss/blood transfusions, potential reduction of the incidence of postsurgical chronic pain and reduction of costs. Evidence deriving from randomized controlled trials suggests that in some situations there are also prolonged benefits of regional anesthesia after catheter removal in addition to the immediate postoperative effects. Unfortunately, there are only few data demonstrating benefits after catheter removal and the evidence of medium- or long-term improvements in health-related quality of life measures is still lacking. This review will give an overview of the advantages and adverse effects of cPNBs.

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“…[261–263]. However, whether catheter migration is possible after correct placement remains unclear [264, 265].…”

Section: Adverse Effectsmentioning

confidence: 99%

The Role of Continuous Peripheral Nerve Blocks

Aguirre

Moral

Cobo

et al. 2012

Anesthesiology Research and Practice

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“…Continuous peripheral nerve blocks have been used to provide a period of extended analgesia. These techniques have generally failed to gain popularity, due to high rates of catheter migration, anesthetic leakage, and the utilization of health care personnel for follow-up 3,4…”

Section: Introductionmentioning

confidence: 99%

Perineural but not systemic low-dose dexamethasone prolongs the duration of interscalene block with ropivacaine: a prospective randomized trial

Kawanishi¹,

Yamamoto²,

Tobetto³

et al. 2014

LRA

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PurposeTo determine the effects of intravenous and perineural dexamethasone on the duration of interscalene brachial plexus block (ISB) with ropivacaine in patients undergoing arthroscopic shoulder surgery.Patients and methodsIn this prospective, randomized, placebo-controlled trial, patients presenting for arthroscopic shoulder surgery with an ISB were randomized to receive ropivacaine 0.75% (group C), ropivacaine 0.75% plus perineural dexamethasone 4 mg (group Dperi), or ropivacaine 0.75% plus intravenous dexamethasone 4 mg (group Div). The primary outcome was the duration of analgesia, defined as the time between performance of the block and the first request for analgesic.ResultsThirty-nine patients were randomized. The median times of sensory block in groups C, Dperi, and Div were 11.2 hours (interquartile range [IQR] 8.0–15.0 hours), 18.0 hours (IQR 14.5–19.0 hours), and 14.0 hours (IQR 12.7–15.1 hours), respectively. Significant differences were observed between groups Dperi and C (P=0.001). Kaplan–Meier analysis for the first analgesic request showed significant differences between groups Dperi and C (P=0.005) and between groups Dperi and Div (P=0.008), but not between groups C and Div.ConclusionPerineural but not intravenous administration of 4 mg of dexamethasone significantly prolongs the duration of effective postoperative analgesia resulting from a single-shot ISB with ropivacaine 0.75%.

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“…Complications associated with the use of CLPB reported in human medicine are subarachnoid placement with a bilateral sensory block (Litz et al 2004), total spinal anaesthesia, a subcapsular renal haematoma, a psoas haematoma and plexopathy, and inadvertent coagulation of the catheter tip impeding catheter removal (Pousman et al 2003). The main complication observed in our study was the abdominal spread of the dye in two out of the first four cadavers in which the plexuses were blocked.…”

Section: Discussionmentioning

confidence: 59%