Abstract
An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.
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Acknowledgments
The authors gratefully acknowledge the assistance of Mr. Russell Sanchez and the pathology service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.
Conflict of interest
Dr. Mariano has received unrestricted educational program funding paid to his institution from I-Flow (Lake Forest, CA, USA) and B Braun (Bethlehem, PA, USA). These companies had absolutely no input into any aspect of the present study conceptualization, design, and implementation, data collection, analysis and interpretation, or manuscript preparation. None of the other authors has any personal financial interests to disclose.
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Congress presentations: 39th Annual regional anesthesiology and acute pain medicine meeting and workshops, (Chicago, IL, USA, April 3–6, 2014).
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Leng, J.C., Harrison, T.K., Miller, B. et al. A pilot study to assess adductor canal catheter tip migration in a cadaver model. J Anesth 29, 308–312 (2015). https://doi.org/10.1007/s00540-014-1922-7
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DOI: https://doi.org/10.1007/s00540-014-1922-7