Prolonged Use of a Continuous Peripheral Nerve Block Catheter for Analgesia after Pediatric Foot and Ankle Surgery

Continuous peripheral nerve blocks (CPNB) have a variety of indications and have been shown to be a safe and effective means of minimizing pain postoperatively. Early studies have indicated duration of catheter use greater than 48 hours as a main contributor to infection risk in CPNBs. Recent studies, though, have suggested that the risk of infection does not increase until 4 days after insertion. In the following case report, we recount our experience in using a continuous popliteal-sciatic peripheral nerve block for postoperative pain control in a pediatric patient following calcaneal and first metatarsal osteotomy. The catheter remained in place for 65 hours postoperatively without signs of local inflammation or infection. The prolonged CPNB use resulted in a significant decrease in postoperative opioid use and pain and increase in patient satisfaction when compared to the same procedure done one year prior on the opposite foot.

Construct Validity of Simulation Model for Training the Ultrasound-Guided Nerve Block and Catheter Placement

Background: Continuous ultrasound-guided peripheral nerve block is a widely practiced technique that can be a challenge for young anesthesiologists. We developed a new simulation model for learning perineural catheter placement. This study aims to test the validity of the model and investigate the learning process of residents on this model. Methods: The simulation model was constructed with partial animal tissue and physical materials. Ultrasound-guided simulation of perineural catheter placement was then performed. Twenty-eight anesthesiologists representing novices, intermediates and experts were required to perform 30 trials within one single day. Practice trials were video-recorded to extract data of task time and performance errors. Construct validity were assessed. Results: Practicing on the simulation model, experts were able to achieve superior task performance, i.e., shorter task time (P < 0.001) and fewer performance errors (P < 0.001), than intermediates and novices. Learning curve recorded from young residents suggested that they were not able to reach the proficiency level as experts within one training day. Conclusions: This hybrid simulation model was capable of training the skills required for continuous ultrasound-guided peripheral nerve block. Future studies under this model need to concern extending the duration of the training phase for residents.