Nerve Block Catheter - Procedure and Pros and Cons

Introduction:

When one undergo surgery and our body's tissues are injured, it triggers various responses, such as hormonal changes, metabolic changes, inflammation, and psychological effects. All of these responses together create what we know as pain. Experts define pain as an unpleasant physical and emotional feeling when there is actual or possible damage to our body's tissues. So, pain is our body's way of telling us that something is wrong or injured.

What Is a Nerve Block Catheter?

A nerve block catheter, also known as a peripheral nerve block catheter or perineural catheter, is a reliable and effective method to reduce pain after surgery. The anesthesiologist will insert a small, flexible, hollow plastic tube placed under the skin where the nerve is located. This procedure is done after completing the surgery. This tube delivers numbing medicine around the nerves to keep the area pain-free. The medicine usually works for about two to four days, depending on the surgery one had and the type of medicine given by the anesthesiologist. It's like wearing a pain-relief device that helps to recover more comfortably after surgery.

How Does the Nerve Block Catheter Work?

A catheter is inserted near the location of pain following your procedure. The catheter has a bottle or filled balloon connected to a pump that holds pain-relieving medication. The catheter will be secured in place with adhesive and tape. The pump makes sure the medicine flows through the catheter at a constant rate. A small case is used to carry the pump while a person moves around. The pump automatically delivers the medication, so the person doesn't need to adjust it unless the medical team asks. Sometimes, the person using the pump may be able to press a button for an extra dose of pain medicine, called a "bolus." The button may lock briefly after one presses it to ensure one doesn't get too much medicine. When it unlocks, the person can press it again if you need more pain relief. Just make sure no one else presses the button without your permission. The pump makes sure the medicine flows through the catheter at a constant rate. So, you'll continuously receive pain relief from the medicine through the catheter while it's connected to the pump.

What Is the Procedure for the Insertion of a Nerve Block?

Equipment Needed:

• One peripheral nerve catheter kit.

• An infusion set is needed to deliver continuous anesthesia near a group of nerves (plexus) with or without an adapter for a nerve stimulator.

• Peripheral nerve stimulator.

• Topical anesthesia.

• Sterile towels.

• Sterile gauze 4*4 pads.

• Sterile forceps.

• Fluid shield face masks.

• Sterile gloves and gowns.

• 20 ml normal saline solution.

• Local anesthetic.

• 5 to 10 ml local anesthetic.

• Occlusive dressing supplies that are used to cover the catheter entry site.

• Gauze and tape were used to secure the catheter to the patient's body.

• Labels stating "Local anesthetic only" and "Not for intravenous injection."

• Anesthesia is administered by a pump (Ex. volumetric pump dedicated to peripheral nerve block infusion).

• A specific observation chart is used for peripheral nerve infusion for patient monitoring.

• Equipment to monitor blood pressure, heart rate, and pulse oximetry.

Additional Equipment Includes:

• Alcohol or ice swab for sensory block.

• Emergency medicines.

• Bag-valve-mask device and oxygen.

• End-trial carbon dioxide monitoring equipment.

• Intubation equipment.

• Ultrasound to guide the placement.

Insertion Technique:

• The usage of sterilized instruments and equipment is crucial for the procedure to prevent infections.

• Doctors use strict guidelines in washing hands, wearing sterile gloves, masks, and hats, and using antiseptic solutions to keep everything clean.

• Short bevel needles are commonly used in regional anesthesia.

• The doctor uses nerve stimulation or ultrasound to help guide the placement of the catheter.

• The nerve stimulation involves using an electric current to spot the nerve and inject the anesthesia.

• The catheter is inserted near the nerve, and the place is secured, continuously delivering pain-relieving medicine.

• To avoid infection, the catheter dressing should be sterile and transparent to monitor the patient's condition.

• The medication's infusion rates and delivery strategies can be adjusted according to the patient's needs.

• Additional pain relief can be attained with patient-controlled bolus doses.

• The patient's vital is checked throughout the procedure to ensure safety and effectiveness.

What Are the Pros and Cons of Nerve Catheters?

Pros:

• Perineural catheters are commonly used for pain management during orthopedic surgery.

• There are different approaches to managing postoperative pain, but the goal is to achieve no pain and quick recovery.

• Continuous infusion of local anesthetics through catheters is preferred due to its effectiveness and lack of better options.

• Studies suggest continuous peripheral nerve blocks (CPNB) provide better pain relief than single-shot nerve blocks or other methods.

• CPNB has been shown to offer superior analgesia for up to 48 hours after major orthopedic surgery without increasing side effects.

• CPNB may also help reduce the risk of chronic pain after surgery and limit inflammation.

• Patients who had CPNB during surgery are satisfied with their pain management and would choose it again for future surgeries.

• CPNB leads to better outcomes in hip and knee arthroplasties.

Cons:

• Cost and Training: Using catheters requires special equipment and training, which can be expensive and may only be available in some places.

• Logistical Challenges: Managing catheters after insertion can be complex and require close monitoring of patients.

• Alternative Methods: Other effective pain management techniques, like local anesthetics with additives or combining nerve blocks with other pain medications, can provide similar benefits without needing catheters.

• Complications: Catheters may increase the risk of infection and other complications, and some patients may experience postoperative neurological symptoms.

• Risk of Falls: Continuous nerve blocks can increase the risk of falls, delaying recovery and discharge from the hospital.

Conclusion:

Continuous peripheral nerve blocks hold great potential to provide adequate pain relief after surgery. With ongoing research and advancements, cPNBs can become more widely used, offering improved pain management and patient outcomes. By addressing the remaining questions through prospective research, we can optimize this use and continue to enhance patient care.