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Peripheral nerve catheters in children: an analysis of safety and practice patterns from the pediatric regional
B J Walker1, J B Long2, G S De Oliveira3
1Department of Anesthesiology, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
Insights
Peripheral nerve catheters (PNCs) are safe for pediatric use, with a 12.1% complication rate. Serious adverse events were rare, supporting PNC safety in children undergoing surgery.
Area of Science:
- Pediatric Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Peripheral nerve catheters (PNCs) are increasingly used in pediatric surgery.
- Limited safety data exists for PNCs in pediatric populations compared to adults.
- This study addresses the incidence of complications associated with PNCs in children.
Purpose of the Study:
- To investigate the safety and complication rates of peripheral nerve catheters in pediatric surgical patients.
- To compare pediatric PNC complication rates with those reported in adult studies.
Main Methods:
- An observational, multi-institutional study utilizing the Pediatric Regional Anesthesia Network (PRAN) database.
- Prospective data collection on patient characteristics, catheter placement, and complications.
- Follow-up of all complications and sequelae until resolution.
Main Results:
- 2074 PNCs were analyzed, with an overall complication incidence of 12.1%.
- Common complications included catheter malfunction, block failure, infection, and vascular puncture.
- No persistent neurologic issues, serious infections, or local anesthetic systemic toxicity were reported (0.04% incidence).
Conclusions:
- Peripheral nerve catheter placement is safe in children, with complication rates comparable to adults.
- While catheter-related issues are frequent, they are generally minor in severity.
- The study supports the continued use of PNCs for pediatric pain management.
Background:
Peripheral nerve catheters (PNCs) are used with increasing frequency in children. Although adult studies have demonstrated safety with this technique, there have been few safety studies in children. The main objective of the current investigation was to examine the incidence of PNC complications in children undergoing surgery.
Methods:
This is an observational, multi-institutional study using the Pediatric Regional Anesthesia Network (PRAN) database. Data pertaining to PNCs were entered prospectively into a secure, online database by each participating centre. Patient characteristics, anatomic location, localization techniques, medications used, and complications were recorded for each catheter. All complications and any sequelae were followed until resolution.
Results:
There were 2074 PNCs included in the study. 251 adverse events and complications were recorded, resulting in an overall incidence (95% CI) of complications of 12.1% (10.7-13.5%). The most common complications were catheter malfunction, block failure, infection, and vascular puncture. There were no reports of persistent neurologic problems, serious infection, or local anaesthetic systemic toxicity, resulting in an estimated incidence (95% CI) of 0.04% (0.001-0.2%). Patients who developed an infection had used the catheters for a greater number of days, median (IQR) of 4.5 (3-7) days compared with 3 (1-3) days in the patients who did not develop an infection, P<0.0001.
Conclusions:
Our data support the safety of placing PNCs in children, with adverse event rates similar to adult studies. Catheter problems are common, yet minor, in severity.
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