Safety and Efficacy of Tunneled Sciatic Nerve Catheters in Combat Injuries: Ukrainian Experience

Surgical treatment of combat injuries often requires continuous analgesia for many weeks, which can be achieved with continuous peripheral nerve blocks. Existing data on the safety and efficacy of sciatic nerve catheterization in civilian and military populations are difficult to extrapolate to the population of combat-injured patients in Ukraine.

To add to the body of evidence on the safety and efficacy of tunneled sciatic nerve catheters for pain control in combat-injured patients treated at Role 3 facilities.

This retrospective study included patients with poorly controlled acute pain due to combat-related lower limb injuries. Sciatic nerve catheters were inserted for pain management. All catheters were tunneled intradermally. Analgesic efficacy was assessed by numeric rating scale of pain intensity, opioid requirement, and pain-related sleep disturbance. Infectious and neurological complications were recorded. Kaplan-Meier analysis was used to estimate the risk of catheter-associated infection over time.

The final study population included 185 cases. The median dwell time of sciatic nerve catheter was 11 days (range from 1 to 57). In 59 cases (31.9%), the catheters remained in situ for more than 14 days. Continuous sciatic nerve block was ineffective in 15.7% cases. The rates of infectious complications, neurological complications and local anesthetic systemic toxicity were 9.2%, 2.2% and 1.1% respectively. One case of neuropathic pain and one case of catheter-associated infection were lost to follow-up. All other complications required no treatment and resolved after removal of catheters. Risk of catheter-associated infection did not increase progressively with increasing catheter dwell time.

In a large-scale war environment, tunneled sciatic nerve catheters provided effective analgesia for painful combat injuries throughout the prolonged wound closure process at the Role 3 level. Tunneled sciatic nerve catheters were associated with a relatively high rate of infections and non-infectious complications, but most complications required no treatment and resolved upon catheter removal. Routine removal of uninfected tunneled sciatic nerve catheters based solely on catheter dwell time is not justified, as the risk of infections does not appear to increase progressively with catheter dwell time.