Reduction of leakage from insertion site during continuous femoral nerve block with catheter-through-needle versus catheter-over-needle technique for postoperative analgesia after total knee arthroplasty: a randomized controlled trial

Background Continuous femoral nerve block (CFNB) is a common procedure used for postoperative analgesia in total knee arthroplasty. Continuous nerve block using a conventional needle (catheter-through-needle/CTN) is complicated by leakage of the anesthetic from the catheter insertion site. A different type of needle (catheter-over-needle/ CON) is now available, which is believed to reduce leakage as the diameter of the catheter is larger than that of the needle. The purpose of this study was to compare the incidence of leakage from the catheter insertion site during CFNB while using CTN and CON for postoperative analgesia after total knee arthroplasty (TKA). Methods This prospective, randomized, single-blinded controlled study included 60 patients who were scheduled for TKA at our facility between May 2016 and November 2017. Patients were randomly allocated to the CTN or CON groups. All patients in both groups received CFNB and sciatic nerve block for postoperative analgesia. The administration of 0.16% levobupivacaine mixed with 6 mg of indigo carmine (a dye added to easily identify leakage) was started at 6 ml/h at the end of surgery. The primary outcome was the incidence of leakage from the catheter insertion site. We further investigated the degree of leakage, the incidence of catheter migration, pain scores using the numerical rating scale at 48 h postoperatively, and the number of days until the operated knee could be flexed 120 degrees postoperatively in both groups. Results The CON group had a significantly lower incidence and degree of leakage from the catheter insertion site. There were no significant differences in other measurement outcomes. Conclusions Use of CON reduces the incidence of leakage from the catheter insertion site during CFNB in the use of postoperative analgesia for total knee arthroplasty. Future research is needed to determine additional benefits of using CON related to decreased leakage. Trial registration The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021537), prospectively registered on 18 March 2016.

Reduction of Leakage from Insertion Site During Continuous Femoral Nerve Block with Catheter-Through-Needle Versus Catheter-Over-Needle Technique for Postoperative Analgesia After Total Knee Arthroplasty: A Randomized Controlled Trial

Background: Continuous femoral nerve block (CFNB) is a common procedure used for postoperative analgesia in total knee arthroplasty. Continuous nerve block using a conventional needle (catheter-through-needle/CTN) is complicated by leakage of the anesthetic from the catheter insertion site. A new type of needle (catheter-over-needle/ CON) is now available, which is believed to reduce leakage as the diameter of the catheter is larger than that of the needle. The purpose of this study was to compare leakage from the catheter insertion site during CFNB when using CTN and CON for postoperative analgesia after total knee arthroplasty (TKA).Methods: This prospective, randomized, single-blinded controlled study included 60 patients who were scheduled for TKA at our facility between May 2016 and November 2017. Patients were randomly allocated to the CTN and CON groups. All patients in the two groups received CFNB and sciatic nerve block for postoperative analgesia. The administration of 0.16% levobupivacaine mixed with 6 mg of indigo carmine ( a dye added to easily identify leakage) was started at 6 ml/h at the end of surgery. The primary outcome was the incidence of leakage from the catheter insertion site. We further investigated the degree of leakage, the incidence of catheter migration, pain scores using the numerical rating scale at 48 hours postoperatively, and the number of days until the operated knee could be flexed 120 degrees postoperatively in both groups. Results: The CON group had a significantly lower incidence of leakage from the catheter insertion site. There were no significant differences in other measurement outcomes.Conclusions: Use of CON reduces the incidence of leakage from the catheter insertion site during CFNB in the use of postoperative analgesia for total knee arthroplasty. Future research is needed to determine additional benefits of using CON related to decreased leakage. Trial registration: The study was registered in the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMIN000021537), prospectively registered on 18 March 2016.

A case of unexpected peripherally inserted central catheter removal from a colorectal cancer patient with cetuximab-induced skin toxicity and contact dermatitis at the peripherally inserted central catheter insertion site: Should we recommend the patient to choose subcutaneous port preferentially?

Introduction: Obtaining central venous access is one of the most commonly performed procedures in cancer patients. However, there are very limited data to guide clinicians when selecting a device for metastatic colorectal cancer patients who received cetuximab. Case description: A 54-year-old male patient with metastatic colorectal cancer treated with cetuximab plus FOLFIRI used peripherally inserted central catheter as intravenous pathway. After eight cycles, the patient suffered cetuximab-induced grade 2 skin toxicity and grade 3 contact dermatitis at the peripherally inserted central catheter insertion site. Finally, he removed the peripherally inserted central catheter and accepted subcutaneous port instead for 2 years without implantation cutaneous complication. Conclusions: We suggest that metastatic colorectal cancer patients treated with cetuximab should be recommended to choose subcutaneous port preferentially to avoid potential risk of unexpected peripherally inserted central catheter removal due to cetuximab-induced skin toxicity or contact dermatitis. Further clinical practices and researches are needed for more profound evidences for better practical suggestions.

Cerebral Abscess – Sequel of Septic Embolization from Thrombo- Phlebitis at Venous Catheter Insertion Site

not availableJ Enam Med Col 2018; 8(3): 177-178