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Home peripheral nerve catheters: the first 24 months of experience at a children's hospital
Andrew Gable1, Candice Burrier2, Jenna Stevens3
1Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus; Heritage College of Osteopathic Medicine, Ohio University, Athens.
Insights
Home peripheral nerve catheters (PNCs) are safe and effective for pediatric orthopedic patients, leading to high ambulatory rates and low pain scores. This study shows successful implementation with minimal complications.
Area of Science:
- Anesthesiology
- Pediatric Orthopedics
- Pain Management
Background:
- Home peripheral nerve catheters (PNCs) are standard for adult orthopedic pain management.
- Their application in pediatric patients is a recent development.
Purpose of the Study:
- To review the demographics and outcomes of pediatric patients who received a PNC at the institution.
Main Methods:
- Retrospective study of pediatric patients undergoing orthopedic procedures with PNCs for pain management.
- Data collected from October 2012 to October 2014.
Main Results:
- 118 pediatric patients (aged 3.2-25.3 years) were included.
- High discharge rate on surgery day (77.1%) with low average PACU pain scores (2.5).
- No major complications; minor issues included early catheter removal (7.6%) due to leakage or dislodging.
Conclusions:
- Home PNC programs are highly successful in pediatric orthopedic settings.
- Demonstrated high ambulatory catheter rates, low pain, nausea, and vomiting.
- No serious complications observed, with manageable minor issues.
Context:
Home peripheral nerve catheters (PNCs) have become common practice for adult patients after major orthopedic surgery. However, use in pediatric patients is a recent application.
Objectives:
The purpose of this study was to review the demographics and outcomes of pediatric patients receiving a PNC at our institution.
Methods:
This retrospective study included patients from October 2012 through October 2014 undergoing orthopedic procedures with a PNC placed for postoperative pain management.
Results:
A total of 118 patients aged 3.2-25.3 years were identified. The types of catheters included femoral (80.5%), interscalene (11.9%), sciatic (5.9%), and supraclavicular (1.7%). The majority of patients were discharged to home on the day of surgery (77.1%). In the postanesthetic care unit, the average pain score was 2.5, the incidence of nausea/emesis was 5.9%, and the need for opioid administration was 50.8%. There were no major complications. Minor complications included a 7.6% rate of early catheter removal with 5.9% of those due to catheter leakage and an unsecure dressing. There was one case of metallic taste in the mouth without other symptoms of local anesthetic toxicity that resolved without further complication.
Conclusion:
The implementation of a home PNC program in pediatric patients at our institution has been highly successful with a high rate of ambulatory catheters, low pain scores, low rates of nausea and vomiting, and no serious complications. Minor complications included leaking of the catheter and early discontinuation of the catheter.
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