Continuous peripheral nerve blocks: An overview

Khaja Mohideen

Anaesthesiologist, Kauvery Hospital, Cantonment, Trichy

Procedure

Catheter is percutaneously inserted and placed adjacent to the nerve.

peripheral1

Indications

  1. Postoperative pain management
  2. Prolonging intraoperative surgical anaesthesia
  3. After trauma for transportation/till surgery
  4. Ischemic pain in peripheral arterial disease
  5. Vasospasm induced by Reynaud disease,
  6. Induce sympathectomy after vascular surgery/reimplantation
  7. Chronic pain syndromes like trigeminal neuralgia, CRPS
  8. Terminal cancer pain

Phantom limb pain

peripheral2
peripheral3
peripheral4

Technique of insertion

  1. Blind – anaesthesia guided
  2. Flouroscopic
  3. Nerve stimulator
  4. USG guided
  5. USG guided with nerve stimulating catheter

Drugs

  1. Bupivacaine 0.15%/Ropivacaine 0.2%
  2. Adjuvants opioids, clonidine\

Dose Indication’s

Depends on the nerve block

  • Bolus only
  • Basal only
  • Basal + bolus

Elastomeric pump

  1. Basal only
  2. Fixed basal/adjustable basal dose
  3. Light weight, smaller in size
  4. Accuracy
  5. Ambulatory patients

Patient Controlled Analgesia (PCA) pump

  1. Basal dose adjustable
  2. Bolus dose adjustable
  3. patient activated
  4. Lockout interval

Benefits

  1. Superior pain relief
  2. Less opioids and its complications
  3. Early discharge, decreased cost
  4. Postoperative cognitive dysfunction
  5. Early rehabilitation after joint surgeries (range of movements)
  6. Long term joint functions (upto 6 months) faster return to routine activities
  7. prevention of chronic pain
  8. Ambulatory surgeries

Complications

Minor complications

  • Catheter obstruction
  • Catheter dislodgement
  • Fluid leakage
  • Infusion pump malfunction
  • Skin irritation/allergic reactions

During procedure 

  • Vascular injury – haematoma
  • Nerve injury
  • Catheter tip away from desired locations (pneumothorax, visceral organs)
  • Catheter migration secondary block failure

Infections

  • Inflammation – 3 4%
  • Catheter colonisation
  • Infection – 0-3.2% (inpatients), below 1% (outpatients)

Neurological complications

Transient neurological complications

  • Long term nerve injury
  • Risk of falls
  • Compartment syndrome
  • Local anaesthetic systemic toxicity
  • Myonecrosis

Risk factors

  1. Axillary/femoral nerve catheters
  2. Lack of antibiotic prophylaxis
  3. ICU admission
  4. Increased infusion duration

Plane blocks

  1. In between muscles or between bone and muscle
  2. Mostly analgesia
  3. No epidural LA side effects like hypotension, paraesthesia
  4. No epidural opioid related side effects,
  5. Anticoagulants
  6. ERAS (Enhanced recovery after major surgery)

1. Abdominal blocks

  • TAP, rectus sheath block etc
  • Laparotomy/ laparoscopy
peripheral5

2. Chest blocks

  1. SAP, ESP, PEC
  2. Breast surgery, rib fractures, VATS
peripheral6

3. Lower limb

  • PENG/PIP
  • Wound debridement, hip fracture
peripheral7
peripheraldr

Dr. S. Khaja Mohideen

Anaesthesiologist

Journals

Kauvery Hospital
Find Doctor
Book Appointment