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Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks: A Randomized Clinical Trial.

  • Author(s): Finneran, John J
  • Swisher, Matthew W
  • Gabriel, Rodney A
  • Said, Engy T
  • Abanobi, Maryann U
  • Abramson, Wendy B
  • Dalstrom, David J
  • Schwartz, Alexandra K
  • Kent, William T
  • Yang, Dongsheng
  • Mascha, Edward J
  • Ilfeld, Brian M
  • et al.
Abstract

WHAT WE ALREADY KNOW ABOUT THIS TOPIC:The fundamental design of perineural catheters has changed little since they were first introduced WHAT THIS ARTICLE TELLS US THAT IS NEW: A novel catheter attached to the back of a suture-shaped needle can be inserted under ultrasound guidance to provide popliteal-sciatic nerve blockadeIn the first two days after foot and ankle surgery, analgesia provided using the suture-type catheters was found to be noninferior to that provided by conventional through-the-needle catheters BACKGROUND:: The basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale. METHODS:Subjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters. RESULTS:During the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239). CONCLUSIONS:Suture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades.

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