Continuous Catheter can be placed in different site for postoperative analgesia. Are their any recommendations for its duration?
As such there is no such strong evidence based recommendation yet. As we require to check and evaluate daily any indwelling line like epidural catheter, it should also be evaluated daily; the site, symptoms and signs of any infection or complications. Reports of using up to 41 days without complication in pediatric patient is reported. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816535/
This question is not eas answered. Is the catheter in a “dirty” area (e.g. femoral crease)? Is the catheter tunneled? Most cases, three days is the optimal time Due to: the peak post surgical pain is (usually) the fist 72 hours; the flow rate and volume with the elastometric balls runs out about three days and the patient is usually discharged within three days.
That being said, I have had patients with catheter insitu for ten days where the patient has the balls changed in the hospital and one last time at discharge (The patient usually removes the catheter while on the phone with the acute pain service nurse). With appropriate home health services and monitoring it could be longer.
Not easily! (Need to proofread prior to hitting “Add answer”). My apologies.
I have kept it (in sciatic nerve—parasacral approach) for ten days! Patient had infected wound after amputation below ankle. Requires daily dressing and in lots of pain (VAS 6/10) He had developed opioid dependence. Thus I want him to keep opioid free. Other analgesic not enough.Worried!! Requested for nerve conduction test- results are normal. Relaxed. Plan to insert again but ....
Should do it again or not?
I agree with Christopher sir in many aspect. The question is not easy to answer as prospective studies in the field is probably lacking to great extent. What we know is mostly from retrospective and case studies. I agree that factors like whether filter is used or not, whether used with elastomeric pump or infusion pump, place etc are some which decides the duration arbitrarily. Although in many place epidural catheter are usually kept for 72 hours postop, it has been kept more than that many a time. I have come across some patients, who themselves wanted extended benefit. As Prajjwal says, I also have kept catheter for 7 to 10 days and without complication, placed in neuraxis. So, probably we can keep for more prolonged time in periphery. Moreover, the material of epidural catheter is non toxic and non reactive to body. Reports of fractured epidural catheter in situ for years being published. So, if mechanically not obstructed, no signs of local complication or infection, probably we can keep longer. But, yes I again agree that it is not easy to answer with much evidence.
Infection rate increases after four days. New article.
Hagen Bomberg, Ina Bayer, Stefan Wagenpfeil, Paul Kessler, Hinnerk Wulf, Thomas Standl, André Gottschalk, Jens Döffert, Werner Hering, Jürgen Birnbaum, Claudia Spies, Bernd Kutter, Jörg Winckelmann, Simone Liebl-Biereige, Winfried Meissner, Oliver Vicent, Thea Koch, Daniel I. Sessler, Thomas Volk, Alexander Raddatz; Prolonged Catheter Use and Infection in Regional Anesthesia: A Retrospective Registry Analysis. Anesthesiology2018;128(4):764-773. doi: 10.1097/ALN.0000000000002105.
In our hospital,we would not normally keep a catheter(epidural or otherwise) in place for over 72 hours without regular review,and we always use transparent occlusive dressings overlying the entry site to aid with that.
Obviously tunnelled catheters may be left in place for longer periods,but the same concerns over entry site sepsis,etc apply.
There are clearly going to be occasions where a catheter is needed for extended analgesia,but I think having a very low threshold for removal,and also keeping sepsis at the front of your mind is a priority.
Continuous peripheral nerve blocks are often used to provide postoperative analgesia, generally catheters remain in situ for 2-7 days. On some occasions , for palliative care , CPNBs can be used up to 45 days.
Attended Regional Anesthesia Course last weekend - there was a case mentioned when PNB catheter stayed for 88 days. Having said that agree with the above posts - most of them can demonstrate evidence of infection after 3-4 days of use, according to the literature.
When I installed a paraneural catheter in the lumbar plexus area, it worked for 3 weeks until there was hyperemia at the entrance to the skin. In aseptic conditions was removed. In the subsequent without consequences.
We frequently leave catheters in place for cancer pain or in the palliative care setting for weeks-months. The site is checked daily And the catheters are tunneled if intended to be in situ >5 days. There is literature to support a preop dose of antibiotics at time of placement (when tunneling, if they aren’t already receiving One for surgery) so this has become my standard practice (Cefazolin 30mg/kg).
We did a study comparing 3 days to 5 days adductor canal catheter for knee arthroplasty and found 5 days better. Anaes Int Care 2018;46:326-331. Fredrickson followed 1500 shoulder catheters left in place for 5 days and only 1 patient needed oral antibiotics for insertion site infection. (Anaesthesia 2016, 71, 373–379) TKA patients need pain relief longer than 5 days with a large proportion taking opioids for up to 6 weeks. More studies needed to see how long we can keep these in place as I suspect longer is better.
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