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AMBULATORY ANESTHESIA

Outpatient Management of Continuous Peripheral Nerve Catheters Placed Using Ultrasound Guidance: An Experience in 620 Patients

Jeffrey D. Swenson, MD^*, Nathan Bay, MD^*, Evelyn Loose, MD^*, Byron Bankhead, MD^*, Jennifer Davis, MD^*, Timothy C. Beals, MD, Nathaniel A. Bryan, MD, Robert T. Burks, MD, and Patrick E. Greis, MD

From the Departments of *Anesthesiology, Health Science Center and Orthopaedic Surgery, Orthopaedic Center, University of Utah, Salt Lake City, UT.

Address correspondence to Jeffrey D. Swenson, MD, Department of Anesthesiology, Health Sciences Center, University of Utah, Salt Lake City, Utah 84132. Address e-mail to jeff.swenson{at}hsc.utah.edu.

BACKGROUND: Continuous peripheral nerve block (CPNB) is an optimal choice for analgesia after orthopedic procedures, but is not commonly used in outpatients because of concern regarding the possibility of catheter-related complications. In addition, it may be difficult to provide adequate patient access to physicians in this setting. We present 620 outpatients who were treated with CPNB using an established protocol.

METHODS: All catheters were placed using direct ultrasound visualization. These patients received extensive oral and written preoperative instruction and were provided continuous telephone access to the anesthesiologist during the postoperative period. All patients were also contacted at home by telephone on the first postoperative day. In addition, each patient was seen and examined by the surgeon within 2 wk of hospital discharge.

RESULTS: Of the 620 patients, there were 190 interscalene (brachial plexus), 206 fascia iliaca (femoral nerve), and 224 popliteal fossa (sciatic nerve) catheters. Two patients (0.3%) had complications related to the nerve block. In both of these patients, the symptoms resolved within 6 wk of surgery. Twenty-six patients (4.2%) required postoperative interventions by the anesthesiologist. One patient returned to the hospital for catheter removal.

CONCLUSIONS: In this large series of outpatients treated with CPNB, there were surprisingly few interventions requiring an anesthesiologist. Likewise, patients were able to manage and remove their catheters at home without additional follow-up. This suggests that with adequate instruction and telephone access to health care providers, patients are comfortable with managing and removing CPNB catheters at home.

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