Zahab S Ahsan1, Brendan Carvalho1, Jeffrey Yao2. 1. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; and the Department of Anesthesia, Stanford University School of Medicine, Stanford; and the Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Redwood City, CA. 2. Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN; and the Department of Anesthesia, Stanford University School of Medicine, Stanford; and the Department of Orthopaedic Surgery, Robert A. Chase Hand and Upper Limb Center, Stanford University Medical Center, Redwood City, CA. Electronic address: jyao@stanford.edu.
Abstract
PURPOSE: To explore the incidence of failure of continuous peripheral nerve blockade (CPNB) after upper extremity operations. METHODS: Patient data regarding postoperative CPNB were retrospectively obtained from our institution's regional anesthesia database. Documented information on the first postoperative day included pain assessment ratings (numerical verbal pain scale, patient-reported breakthrough pain upon perceived return of sensation, appearance of the catheter site, complications, time of return of sensation, day of return of sensation, residual blockade, patient satisfaction with the block, and whether patient would receive the block again). RESULTS: A total of 207 patients received CPNB for postoperative analgesia. The failure rate on the first postoperative day for infraclavicular (133 patients) and supraclavicular (58 patients) CPNB was 19% and 26%, respectively. Interscalene CPNB (16 patients) yielded 3 incidences of failure. No significant difference was found between supraclavicular and infraclavicular block techniques. In addition, no significant differences were found between the incidences of CPNB failures with potentially more painful surgeries involving bone compared with potentially less painful soft tissue procedures. CONCLUSIONS: The CPNB technique used for hand surgery postoperative analgesia was associated with nontrivial failure rates. The potential of CPNB failure and resulting breakthrough pain upon recovery from the primary nerve block is important to help establish patient expectations. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
PURPOSE: To explore the incidence of failure of continuous peripheral nerve blockade (CPNB) after upper extremity operations. METHODS:Patient data regarding postoperative CPNB were retrospectively obtained from our institution's regional anesthesia database. Documented information on the first postoperative day included pain assessment ratings (numerical verbal pain scale, patient-reported breakthrough pain upon perceived return of sensation, appearance of the catheter site, complications, time of return of sensation, day of return of sensation, residual blockade, patient satisfaction with the block, and whether patient would receive the block again). RESULTS: A total of 207 patients received CPNB for postoperative analgesia. The failure rate on the first postoperative day for infraclavicular (133 patients) and supraclavicular (58 patients) CPNB was 19% and 26%, respectively. Interscalene CPNB (16 patients) yielded 3 incidences of failure. No significant difference was found between supraclavicular and infraclavicular block techniques. In addition, no significant differences were found between the incidences of CPNB failures with potentially more painful surgeries involving bone compared with potentially less painful soft tissue procedures. CONCLUSIONS: The CPNB technique used for hand surgery postoperative analgesia was associated with nontrivial failure rates. The potential of CPNB failure and resulting breakthrough pain upon recovery from the primary nerve block is important to help establish patient expectations. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
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