Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients

The increasing popularity of continuous peripheral nerve blocks (CPNBs) warrants further study of their adverse effects and complications.

Anterior sciatic, femoral, and interscalene brachial plexus CPNBs were performed preoperatively using standardized catheter techniques in orthopedic patients prior to general or spinal anesthesia. Complications and adverse effects related to CPNBs were prospectively evaluated.

We analyzed 1398 CPNBs in 849 consecutive patients (mean age 65 +/- 13 yr) between 2002 and 2004. Two-hundred-twenty-one patients received interscalene, 628 patients femoral, and 549 sciatic CPNBs, respectively. In all the latter patients, we performed both femoral and sciatic CPNBs. Overall, there were 9 cases of local inflammation at the insertion site (0.6%), and 3 local infections (pustule) (0.2%, all femoral CPNBs). In one patient undergoing a femoral technique, a retroperitoneal hematoma led to compression injury of the femoral nerve. Complete denervation of the quadriceps femoris muscle was confirmed by electroneuromyography. No other major neurological complications were noted. There was one case of methemoglobinemia associated with an interscalene CPNB. Vascular puncture occurred in approximately 6% of patients undergoing femoral and sciatic CPNBs. Catheter rupture was noted in one patient.

Our results add to the evidence that major complications from CPNBs are rare. However, minor adverse effects associated with CPNBs may be more common.