Continuous peripheral nerve block for ambulatory surgery

Background and Objectives: Continuous peripheral nerve block (CPNB) can pro vide surgical anesthesia, prolonged postoperative analgesia, and acceptable side effects. Despite these advantages, CPNB is not in widespread use. Rec ently a new CPNB catheter system (Contiplex, B. Braun, Bethlehem, PA) was d eveloped based on an insulated Tuohy needle, which allows for injection of local anesthetic and catheter insertion without disconnection or needle mov ement. At present, no clinical studies exist describing this system. Methods: Data were prospectively gathered for 1 year from 228 patients in a n ambulatory surgery center. All CPNB were performed using the Contiplex sy stem to provide anesthesia and postoperative analgesia. CPNB were performed using 5 upper and lower extremity techniques. Postsurgery local anesthetic was infused and at 24 hours, a rebolus of local anesthetic was performed. The CPNB catheter was removed and patients were examined for loss of sensat ion. Patients were then discharged. Results: Initial peripheral block was successful in 94% of patients. Failed nerve block requiring general anesthesia occurred in 6%. The catheter was patent and functional in 90% of patients at 24 hours, and 8% of patients re quired more than 10 mg of intravenous morphine by 24 hours postsurgery. In the postanesthesia care unit (PACU), only 4 patients (1.7%) required treatm ent for nausea. At 24 hours and 7 days postsurgery. no patient reported a d ysesthesia. Conclusions: CPNB using the insulated Tuohy catheter system offered accepta ble anesthesia and prolonged pain relief postsurgery. There were few side e ffects.