Does a catheter over needle system reduce infusate leak in continuous peripheral nerve blockade: a randomised...

Area of Science:

• Anesthesiology
• Regional Anesthesia
• Pain Management

Background:

• Continuous peripheral nerve blockade is crucial for post-procedural analgesia.
• Local anesthetic leakage from nerve catheters can lead to complications like dislodgement and infection, potentially compromising block efficacy.

Purpose of the Study:

• To compare local anesthetic leak rates between catheter over needle (CON) and catheter through needle (CTN) systems.
• To evaluate secondary outcomes including insertion time, ultrasound visibility, catheter dislodgement, and postoperative analgesia.

Main Methods:

• A randomized controlled trial involving 110 patients undergoing total knee arthroplasty.
• Patients received either a CON (Pajunk® E-Cath) or CTN (Pajunk® SonoLong) perineural catheter.
• Outcomes measured included leak rate, insertion time, ultrasound needle visibility (Likert scale), catheter dislodgement instances, and patient-reported analgesia at postoperative days 1 and 2.

Main Results:

• No significant difference in local anesthetic leak rates between CON (1.8%) and CTN (3.7%) groups (P=0.618).
• The CON system demonstrated significantly faster insertion times (357s vs. 482s; P=0.004) but poorer ultrasound needle visibility (3.31 vs. 3.89; P=0.001).
• All seven instances of inadvertent catheter dislodgement occurred in the CTN group (P=0.006), with no significant differences in postoperative analgesia between groups on days 1 and 2.

Conclusions:

• Both CON and CTN systems exhibit low local anesthetic leak rates, contrary to pilot data expectations.
• The CON system presents potential advantages regarding faster insertion and reduced risk of catheter dislodgement.
• While ultrasound visibility was poorer with the CON system, its safety profile regarding dislodgement may favor its use in specific clinical scenarios.