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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

  1. Williams BA, Kentor ML, Vogt MT, et al. Reduction of verbal pain scores after anterior cruciate ligament reconstruction with two-day continuous femoral nerve block: a randomized clinical trial. Anesthesiology 2006;104:315–27.[Web of Science][Medline]
  2. James WD, White SW, Yanklowitz B. Allergic contact dermatitis to compound tincture of benzoin. J Am Acad Dermatol 1984;11:847–50.[Web of Science][Medline]
  3. Patel N, Smith CE, Pinchak AC, Hancock DE. The influence of tape type and of skin preparation on the force required to dislodge angiocatheters. Can J Anaesth 1994; 41:738–41.[Web of Science][Medline]
  4. Mikhail GR, Selak L, Salo S, Balle MR. The efficacy of adhesives in the application of wound dressings. J Burn Care Rehabil 1989;10:216–9.[Medline]
  5. Mikhail GR, Selak L, Salo S. Reinforcement of surgical adhesive strips. J Dermatol Surg Onc 1986;12:904–5.
  6. Greengrass RA, Nielsen KC. Management of peripheral nerve block catheters at home. Int Anesthesiol Clin 2005;43:79–87.[Medline]
  7. Cuvillon P, Ripart J, Lalourcey L, et al. The continuous femoral nerve block catheter for postoperative analgesia: bacterial colonization, infectious rate and adverse effects. Anesth Analg 2001;93:1045–9.[Abstract/Free Full Text]




This Article
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press