Newly Published
Perioperative Medicine  |   January 2020
Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks: A Randomized Clinical Trial
Author Notes
  • From the Departments of Anesthesiology (J.J.F., M.W.S., R.A.G., E.T.S., M.U.A., W.B.A., B.M.I.) and Orthopedic Surgery (D.J.D., A.K.S., W.T.K.), University of California San Diego, San Diego, California; Outcomes Research Consortium, Cleveland, Ohio (J.J.F., M.W.S., R.A.G., D.Y., E.J.M., B.M.I.); Department of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.Y., E.J.M.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Interim analyses of the results of this study were presented in abstract form at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas, Nevada, on April 12, 2019, and the 38th Annual European Society of Regional Anesthesia Congress in Bilbao, Spain, from September 11 to 14, 2019.
    Interim analyses of the results of this study were presented in abstract form at the 44th Annual Regional Anesthesiology and Acute Pain Medicine Meeting in Las Vegas, Nevada, on April 12, 2019, and the 38th Annual European Society of Regional Anesthesia Congress in Bilbao, Spain, from September 11 to 14, 2019.×
  • Submitted for publication July 16, 2019. Accepted for publication December 17, 2019.
    Submitted for publication July 16, 2019. Accepted for publication December 17, 2019.×
  • Correspondence: Address correspondence to Dr. Finneran: University of California San Diego, Department of Anesthesiology, 200 West Arbor Drive MC 8770, San Diego, California 92103-8770. jfinneran@ucsd.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Technology / Equipment / Monitoring
Perioperative Medicine   |   January 2020
Suture-method versus Through-the-needle Catheters for Continuous Popliteal-sciatic Nerve Blocks: A Randomized Clinical Trial
Anesthesiology Newly Published on January 24, 2020. doi:https://doi.org/10.1097/ALN.0000000000003145
Anesthesiology Newly Published on January 24, 2020. doi:https://doi.org/10.1097/ALN.0000000000003145
Abstract

Editor’s Perspective:

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 blockade

  • In 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.