Anesth Analg 2007;104:1309-1310
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000260353.11142.d4
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Skin Reactions at the Femoral Perineural Catheter Insertion Site: Retrospective Summary of a Randomized Clinical Trial
Brian A. Williams, MD, MBA,
Monica A. Bolland, MD,
Steven L. Orebaugh, MD,
Matthew T. Bottegal, BS, and
Michael L. Kentor, MD
Department of Anesthesiology (Williams, Bolland, Orebaugh)
Department of Orthopaedic Surgery (Bottegal)
Department of Anesthesiology, UPMC South Side, Pittsburgh, PA, williamsba{at}anes.upmc.edu (Kentor)
To the Editor:
We report on skin reactions under femoral perineural catheter dressings. These data were acquired as part of a study assessing the efficacy of a 2-day infusion of local anesthetic via a femoral catheter inserted at the time of surgery in patients undergoing anterior cruciate ligament repair (1). To prevent catheter dislodgment, catheters were subcutaneously tunneled, and we applied either Mastisol (Ferndale Laboratories, Ferndale, MI) or benzoin (Sepp®, Medi-Flex, Leawood, KS) as a topical adhesive. Four small biocclusive dressings were covered by one large (10 cm x 12 cm) dressing. Margins were covered with 5 cm-wide, zinc oxide Hy-Tape (Hy-Tape® International, Patterson, NY). Thirteen patients of 233 (5.6%) from this trial reported tenderness, bleeding, or other skin problems. One patient required topical neomycin, and another oral diphenhydramine and topical hydrocortisone.
We were unable to determine whether the skin reactions were sequelae of benzoin (versus Mastisol), and/or due to the airtight seal created by the Hy-Tape®. We have since become aware that benzoin has a 13% incidence of allergic skin reactions (2), and that Mastisol® is a better adhesive than benzoin (3–5). The airtight seal may have prevented evaporation of local anesthetic solution or serous fluid. We have not encountered these skin reactions since abandoning the use of benzoin and Hy-Tape replacing them with Mastisol® along with the highly absorptive Aquacel® Hydrofiber dressing (ConvaTec, Princeton, NJ) under the biocclusive dressing. There is a very low incidence (0.01%) of superficial infections associated with outpatient perineural catheters (6) and, as was the case in our patients, these sequelae tend to resolve spontaneously after removal (7).
REFERENCES
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