Contrast-enhanced paravertebrogram to confirm paravertebral catheter position in elective thoracic surgery: a proof of concept study

Background Paravertebral pain catheters have been shown to be equally effective as epidural pain catheters for postoperative analgesia after thoracic surgery with the possible additional benefit of less hemodynamic effect. However, a methodology for verifying correct paravertebral catheter placement has not been tested or objectively confirmed in previous studies. The aim of the current study was to describe a technique to confirm the correct position of a paravertebral pain catheter using a contrast-enhanced paravertebrogram. Methods A retrospective cohort proof of concept study was performed including 10 consecutive patients undergoing elective thoracic surgery with radiographic contrast-enhanced confirmation of intraoperative paravertebral catheter placement (paravertebrogram). Results The results of the paravertebrograms, which were done in the operating room at the end of the procedure, verified correct paravertebral catheter placement in 10 of 10 patients. The radiographs documented dissemination of local anesthetic within the paravertebral space. Conclusion This proof of concept study demonstrated that a contrast-enhanced paravertebrogram could be used in conjunction with standard postoperative chest radiography to add valuable information for the assessment of paravertebral catheter placement. This technique has the potential to increase the accuracy and efficiency of postoperative analgesia, and to set a quality standard for future studies of paravertebral pain catheters.

Experiences with an intra-articular pain catheter in approx. 3.000 TKR over a period of 6.5 years

The optimal pain treatment after a TKR has been under discussion for a long time. With the use of pain catheters you can save analgesics and opiates. A femoral and sciatic nerve catheter became already established. Disadvantages are a the time-consuming application of the catheter with neuro-tracer or ultrasound as well as facing possible palsy, especially of the extension muscle of the knee, which disturbs the autonomous mobility of the patients. Would it be possible to treat the postoperative pain sufficiently and preserve the active mobility of the patients by using an intraarticular pain catheter, that will not influence the muscle power, which can also be used time-sparing during TKR surgeries in combination with an external, continuous local anesthesia from a portable valve-controlled reservoir? We report on case series of our clinic from July 2010 till October 2017, which included more than 3.000 TKRs. We made use of 4 different catheter and pump systems (for example the Painbuster). The LA used was Ropivacaine. With a postoperative rate of fluid flow of 10-15 ml/h in a concentration of 3,75 mg/ml (0,375%) Ropivacaine Hydrochloride over a period of 2-3 days, we achieved a good pain reduction comparable to a femoral catheter and perfusor application of 2,0 mg/ml (0,2%) Ropivacaine. Most patients feel strong pain following a TKR due to the special vulnerability of the knee joints with large inner surface of the joint and thin soft-tissue coverage. The established pain catheters positioned beside the femoral nerve need a relative long turnover time (the time from the end of the previous surgical procedure to the beginning of the next) and have an important disadvantage of palsy of the quadriceps muscle with the risk of falling due to the immobilization of the patient. The intra-articular painbuster systems lead to excellent pain reduction and fast mobilization of the patient with full control of muscle power. The application of the catheter during the operation is not time consuming and you will not face longer turnover and surgery times.

TINGKAT NYERI PEMASANGAN KATETER MENGGUNAKAN JELI OLES DAN JELI YANG DIMASUKKAN URETHRA

This research aimed to show the effectiveness of catheters in men using the included urethral gel with gel applied to the catheter to the client pain response in adult inpatient ward 3 class in PKU Muhammadiyah Yogyakarta. The research design used Quasi-eksperiment with posttest only control group. Mann Whitney statistical test result p = 0.275 thus concluded there were no significant differences in the level of pain between groups gel smeared with gel group entered the urethra.Keywords: the level of pain catheter, rab gel, gel included urethra