Optimizing Catheter Insertion Technique for Ultrasound-guided Continuous Peripheral Nerve Blocks
| Status: | Active, not recruiting |
|---|---|
| Conditions: | Post-Surgical Pain |
| Therapuetic Areas: | Musculoskeletal |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 11/25/2017 |
| Start Date: | October 2011 |
| End Date: | July 2020 |
Continuous peripheral nerve blocks (CPNB; also known as "perineural" catheters) provide
target-specific pain control for a variety of surgeries. There has been increasing interest
in the use of ultrasound guidance for regional anesthesia, and many techniques using
ultrasound alone for perineural catheter insertion have been described. Catheters may be
placed at various points along the brachial plexus (for upper extremity procedures) or in
proximity to the femoral and/or sciatic nerve (for lower extremity procedures). To date, the
optimal ultrasound scanning technique, catheter insertion endpoint, catheter placement
location per indication, for the majority of ultrasound-guided continuous peripheral nerve
blocks remain unknown. This study will help provide important information related to optimal
ultrasound scanning techniques and will help identify ways to improve the success rates,
onset times, and analgesic effectiveness of these techniques for real patients undergoing
surgical procedures.
target-specific pain control for a variety of surgeries. There has been increasing interest
in the use of ultrasound guidance for regional anesthesia, and many techniques using
ultrasound alone for perineural catheter insertion have been described. Catheters may be
placed at various points along the brachial plexus (for upper extremity procedures) or in
proximity to the femoral and/or sciatic nerve (for lower extremity procedures). To date, the
optimal ultrasound scanning technique, catheter insertion endpoint, catheter placement
location per indication, for the majority of ultrasound-guided continuous peripheral nerve
blocks remain unknown. This study will help provide important information related to optimal
ultrasound scanning techniques and will help identify ways to improve the success rates,
onset times, and analgesic effectiveness of these techniques for real patients undergoing
surgical procedures.
Primary Aim: To determine if there is an optimal scanning technique for ultrasound-guided
perineural catheter insertion that will result in the most accurate tip placement in
proximity to the target nerve or plexus.
Secondary Aim: To determine if there is an optimal location for ultrasound-guided perineural
catheter insertion along a target nerve or plexus that will result in maximum local
anesthetic infusion benefits.
perineural catheter insertion that will result in the most accurate tip placement in
proximity to the target nerve or plexus.
Secondary Aim: To determine if there is an optimal location for ultrasound-guided perineural
catheter insertion along a target nerve or plexus that will result in maximum local
anesthetic infusion benefits.
Inclusion criteria:
- At least 18 years of age;
- Undergoing unilateral, upper (at or distal to the elbow) or lower (hip or distal)
extremity orthopedic surgery, with moderate-to-severe postoperative pain expected; and
- Desiring a continuous perineural catheter for postoperative analgesia.
Exclusion criteria:
- Patients who will have difficulty understanding the study protocol or caring for the
infusion pump/catheter system; or
- Patients with any known contraindication to study medications, insulin-dependent
diabetes mellitus, neuropathy of any etiology in the affected extremity;
- Patients with a contraindication to regional blockade (eg, clotting deficiency);
- Patients with any known acute or chronic hepatic or renal insufficiency or failure;
- Patients with any additional surgical site outside of the catheter-affected area (eg,
iliac crest bone graft in addition to hand surgery);
- Patients with chronic opioid use (defined as daily use for more than 4 weeks prior to
surgery) or active illicit substance abuse;
- Patient weighing < 40 kg;
- Pregnancy;
- Incarceration; or
- Inability to communicate with the investigators and hospital staff.
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