Comparison of catheter tip migration using flexible and stimulating catheters inserted into the adductor canal in a cadaver model
Use of adductor canal blocks and catheters for perioperative pain management following total knee arthroplasty is becoming increasingly common. However, the optimal equipment, timing of catheter insertion, and catheter dislodgement rate remain unknown. A previous study has suggested, but not proven, that non-tunneled stimulating catheters may be at increased risk for catheter migration and dislodgement after knee manipulation. We designed this follow-up study to directly compare tip migration of two catheter types after knee range of motion exercises. In a male unembalmed human cadaver, 30 catheter insertion trials were randomly assigned to one of two catheter types: flexible or stimulating. All catheters were inserted using an ultrasound-guided short-axis in-plane technique. Intraoperative knee manipulation similar to that performed during surgery was simulated by five sequential range of motion exercises. A blinded regional anesthesiologist performed caliper measurements on the ultrasound images before and after exercise. Changes in catheter tip to nerve distance (p = 0.547) and catheter length within the adductor canal (p = 0.498) were not different between groups. Therefore, catheter type may not affect the risk of catheter tip migration when placed prior to knee arthroplasty.
KeywordsRegional anesthesia Adductor canal block Perineural catheter Total knee arthroplasty Catheter dislodgement
The authors gratefully acknowledge the assistance of Mr. Russell Sanchez and the Pathology Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Conflict of interest
Dr. Mariano has received unrestricted educational program funding paid to his institution from I-Flow (Lake Forest, CA, USA) and B Braun (Bethlehem, PA, USA). These companies had absolutely no input into any aspect of the present study conceptualization, design, and implementation; data collection, analysis and interpretation; or manuscript preparation. None of the other authors has any personal financial interests to disclose.
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