What is a Continuous Catheter Nerve Block?

Continuous catheter nerve blocks explained by Denver, Golden, Aurora, Boulder, Broomfield, Jefferson, and Littleton Colorado’s top pain doctors

Cancer PainA continuous catheter nerve block is a form of pain treatment that involves having a catheter placed through the skin close to peripheral nerves. A small container of pain medication (an analgesic) is connected to the catheter in order to continuously deliver the medication to the region where the pain originated.

Continuous catheter nerve blocks are also commonly referred to as continuous peripheral nerve blocks and this procedure was utilized as early as 1946. Case reports that were published around this time explain that a cork was taped to the patient’s chest and then a needle was inserted through it as a means of stabilizing the needle during the placement. However, medical advancements have drastically improved this process and it is now a clinically accepted and well-recognized analgesic approach.

How is a Continuous Catheter Nerve Block Performed?

Procedure PreperationBefore the procedure begins, a patient lies on their stomach and the skin is thoroughly cleaned in order to reduce the chance of an infection at the injection site. If heavy sedation is necessary, an IV is used to administer the analgesic and vital signs such as blood pressure, respiration, and heart rate are closely monitored. If the patient is not sedated, an anesthetic will still be used on the skin before the injection. The physician then utilizes ultrasound technology or a twitch-monitor as well as nerve stimulation while the needle is being placed to ensure that it reaches the target nerves.

Once the targeted nerve is correctly located, a catheter is inserted through the needle and then the needle is withdrawn so that only the catheter remains in position. A bandage and liquid adhesive are used to hold the catheter in place and then the small container that is filled with medication is connected to the catheter. The procedure takes approximately 15 minutes and allows medication to be infused continuously for lasting pain relief.

The benefits of receiving a continuous catheter nerve block include reducing a patient’s need for large doses of orally administered pain relievers and less side effects. For example, a study that compared the effects of continuous catheter nerve blocks to opioid consumption for pain relief reported that nerve blocks decreased the occurrence of vomiting and nausea by approximately 65% to 81%. The continuous nerve block also resulted in heightened mood, an improvement in sleep by at least two hours, and reduced hospital stays.

Additional reports have indicated that continuous catheter nerve blocks are quite effective at improving the symptoms of various chronic pain conditions. Terminal cancer patients have also experienced significant pain relief from continuous nerve blocks and are often able to spend more time with friends and family and less time at the hospital.

Continuous catheter nerve blocksare non-invasive and fairly safe though a few side effects are associated with this procedure. These may include skin irritation, fluid leakage, catheter dislodgement, infection, bleeding, and nerve damage.

Conditions Related to Continuous Cather Nerve Blocks

Phantom Limb PainA major challenge that pain management specialists often face is finding ways to continuously administer pain medication after surgery. According to the Journal of Anesthesiology Research and Practice, surgery causes 50% to 70% of patients to experience moderate or severe pain after the surgical procedure. However, a large number of patients currently have shorter hospital stays due to techniques such as continuous catheter nerve blocks.

Nowadays, the medical community is placing more emphasis on providing patients with shorter hospital stays as well as enhanced outpatient care after surgery. Accordingly, continuous catheter nerve blocks provide consistent pain relief that lasts well beyond the average eight to 20 hours that is typically experienced after a single injection of anesthesia.

Continuous catheter nerve blocks have been successfully administered in ambulatory outpatient pain clinics as well. This provides patients with the opportunity to receive effective pain management from the comfort of their homes. The following conditions have also been successfully treated with continuous catheter nerve blocks:

  • Back and neck pain
  • Cancer-related pain
  • Complex regional pain syndrome
  • Post-amputation pain
  • Peripheral embolism
  • Phantom limb pain
  • Herpetic neuralgia
  • Brachial plexus neuropathies
  • Trigeminal neuralgia (chronic pain syndrome)
  • Pain management for intensive post-operative physical therapy

Conclusion

A continuous catheter nerve blockis a form of pain management that is effective at treating various conditions as well as chronic pain. This non-surgical procedure is well-established and has been thoroughly evaluated through clinical research that has demonstrated positive results regarding the safety and efficacy of this approach. More specifically, it is an optimal substitute for most prescription pain medications and orally administered opioids. Additionally, continuous catheter nerve blocks provide patients with an opportunity to be released from the hospital shortly after surgery or to receive treatment in an outpatient setting.

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References

  1. Aguirre J, Del-Moral A, Cobo I, Borgeat A, Blumenthal S. The role of continuous peripheral nerve blocks. Anesthesiology Research and Practice. 2012;7:1-11.
  2. Capdevila X, Ponrouch M, Choquet O. Continuous peripheral nerve blocks in clinical practice. Curr Opin Anesth. 2008;21:619-623.
  3. Ilfield B, Loland V, Sandhu N, Suresh P, Bishop M, et al. Continuous femoral nerve blocks: The impact of catheter tip location relative to the femoral nerve (anterior verse posterior) on quadriceps weakness and cutaneous sensory block. Regional Anesthesia. 2012;115(3):721-727.
  4. McLeod G. Peripheral nerve catheter techniques. Anesth Int Care Medicine. 2010;11(3):109-110.
  5. Pacenta H, Kaddoum R, Burgoyne L. Continuous tunneled femoral nerve block for palliative care of a patient with metastatic osteosarcoma. Anaesth Intensive Care. 2010;38(3):563-565.