Skip to main content
SpringerLink
Log in

Comparison of catheter tip migration using flexible and stimulating catheters inserted into the adductor canal in a cadaver model

  • Short Communication
  • Published:
Journal of Anesthesia Aims and scope Submit manuscript

Abstract

Use of adductor canal blocks and catheters for perioperative pain management following total knee arthroplasty is becoming increasingly common. However, the optimal equipment, timing of catheter insertion, and catheter dislodgement rate remain unknown. A previous study has suggested, but not proven, that non-tunneled stimulating catheters may be at increased risk for catheter migration and dislodgement after knee manipulation. We designed this follow-up study to directly compare tip migration of two catheter types after knee range of motion exercises. In a male unembalmed human cadaver, 30 catheter insertion trials were randomly assigned to one of two catheter types: flexible or stimulating. All catheters were inserted using an ultrasound-guided short-axis in-plane technique. Intraoperative knee manipulation similar to that performed during surgery was simulated by five sequential range of motion exercises. A blinded regional anesthesiologist performed caliper measurements on the ultrasound images before and after exercise. Changes in catheter tip to nerve distance (p = 0.547) and catheter length within the adductor canal (p = 0.498) were not different between groups. Therefore, catheter type may not affect the risk of catheter tip migration when placed prior to knee arthroplasty.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Hanson NA, Allen CJ, Hostetter LS, Nagy R, Derby RE, Slee AE, Arslan A, Auyong DB. Continuous ultrasound-guided adductor canal block for total knee arthroplasty: a randomized, double-blind trial. Anesth Analg. 2014;118:1370–7.

    Article  CAS  PubMed  Google Scholar 

  2. Kim DH, Lin Y, Goytizolo EA, Kahn RL, Maalouf DB, Manohar A, Patt ML, Goon AK, Lee YY, Ma Y, Yadeau JT. Adductor canal block vs femoral nerve block for total knee arthroplasty: a prospective, randomized, controlled trial. Anesthesiology. 2014;120:540–50.

    Article  CAS  PubMed  Google Scholar 

  3. Mudumbai SC, Kim TE, Howard SK, Workman JJ, Giori N, Woolson S, Ganaway T, King R, Mariano ER. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA. Clin Orthop Relat Res. 2014;472:1377–83.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Mariano ER, Perlas A. Adductor canal block for total knee arthroplasty: the perfect recipe or just one ingredient? Anesthesiology. 2014;120:530–2.

    Article  PubMed  Google Scholar 

  5. Lund J, Jenstrup MT, Jaeger P, Sorensen AM, Dahl JB. Continuous adductor-canal-blockade for adjuvant post-operative analgesia after major knee surgery: preliminary results. Acta Anaesthesiol Scand. 2011;55:14–9.

    Article  CAS  PubMed  Google Scholar 

  6. Mariano ER, Kim TE, Wagner MJ, Funck N, Harrison TK, Walters T, Giori N, Woolson S, Ganaway T, Howard SK. A randomized comparison of proximal and distal ultrasound-guided adductor canal catheter insertion sites for knee arthroplasty. J Ultrasound Med. 2014;33:1653–62.

    Article  PubMed  Google Scholar 

  7. Jaeger P, Zaric D, Fomsgaard JS, Hilsted KL, Bjerregaard J, Gyrn J, Mathiesen O, Larsen TK, Dahl JB. Adductor canal block vs femoral nerve block for analgesia after total knee arthroplasty: a randomized, double-blind study. Reg Anesth Pain Med. 2013;38:526–32.

    Article  CAS  PubMed  Google Scholar 

  8. Shah NA, Jain NP. Is continuous adductor canal block better than continuous femoral nerve block after total knee arthroplasty? Effect on ambulation ability, early functional recovery and pain control: a randomized controlled trial. J Arthroplasty. 2014 (Epub ahead of print).

  9. Ahsan ZS, Carvalho B, Yao J. Incidence of failure of continuous peripheral nerve catheters for postoperative analgesia in upper extremity surgery. J Hand Surg Am. 2014;39:324–9.

    Article  PubMed  Google Scholar 

  10. Leng JC, Harrison TK, Miller B, Howard SK, Conroy M, Udani A, Shum C, Mariano ER. A pilot study to assess adductor canal catheter tip migration in a cadaver model. J Anesth 2014 (Epub ahead of print).

  11. Ilfeld BM. Continuous peripheral nerve blocks: a review of the published evidence. Anesth Analg. 2011;113:904–25.

    Article  PubMed  Google Scholar 

  12. Ilfeld BM, Fredrickson MJ, Mariano ER. Ultrasound-guided perineural catheter insertion: three approaches but few illuminating data. Reg Anesth Pain Med. 2010;35:123–6.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Gandhi K, Lindenmuth DM, Hadzic A, Xu D, Patel VS, Maliakal TJ, Gadsden JC. The effect of stimulating vs conventional perineural catheters on postoperative analgesia following ultrasound-guided femoral nerve localization. J Clin Anesth. 2011;23:626–31.

    Article  PubMed  Google Scholar 

  14. Farag E, Atim A, Ghosh R, Bauer M, Sreenivasalu T, Kot M, Kurz A, Dalton JE, Mascha EJ, Mounir-Soliman L, Zaky S, Ali Sakr Esa W, Udeh BL, Barsoum W, Sessler DI. Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion: a randomized, blinded trial. Anesthesiology. 2014;121:239–48.

    Article  PubMed  Google Scholar 

  15. Hayek SM, Ritchey RM, Sessler D, Helfand R, Samuel S, Xu M, Beven M, Bourdakos D, Barsoum W, Brooks P. Continuous femoral nerve analgesia after unilateral total knee arthroplasty: stimulating vs nonstimulating catheters. Anesth Analg. 2006;103:1565–70.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Morin AM, Eberhart LH, Behnke HK, Wagner S, Koch T, Wolf U, Nau W, Kill C, Geldner G, Wulf H. Does femoral nerve catheter placement with stimulating catheters improve effective placement? A randomized, controlled, and observer-blinded trial. Anesth Analg. 2005;100:1503–10.

    Article  PubMed  Google Scholar 

  17. Sandhu NS, Sidhu DS, Capan LM. The cost comparison of infraclavicular brachial plexus block by nerve stimulator and ultrasound guidance. Anesth Analg. 2004;98:267–8.

    Article  PubMed  Google Scholar 

  18. Symons B, Wuest S, Leonard T, Herzog W. Biomechanical characterization of cervical spinal manipulation in living subjects and cadavers. J Electromyogr Kinesiol. 2012;22:747–51.

    Article  PubMed  Google Scholar 

  19. Mariano ER, Yun RD, Kim TE, Carvalho B. Application of echogenic technology for catheters used in ultrasound-guided continuous peripheral nerve blocks. J Ultrasound Med. 2014;33:905–11.

    Article  PubMed  Google Scholar 

  20. Kan JM, Harrison TK, Kim TE, Howard SK, Kou A, Mariano ER. An in vitro study to evaluate the utility of the “air test” to infer perineural catheter tip location. J Ultrasound Med. 2013;32:529–33.

    PubMed  Google Scholar 

  21. Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein SM. Continuous peripheral nerve block for ambulatory surgery. Reg Anesth Pain Med. 2001;26:209–14.

    Article  CAS  PubMed  Google Scholar 

  22. Ip VH, Tsui BC. The catheter-over-needle assembly facilitates delivery of a second local anesthetic bolus to prolong supraclavicular brachial plexus block without time-consuming catheterization steps: a randomized controlled study. Can J Anaesth. 2013;60:692–9.

    Article  PubMed  Google Scholar 

  23. Mariano ER, Kim TE, Funck N, Walters T, Wagner MJ, Harrison TK, Giori N, Woolson S, Ganaway T, Howard SK. A randomized comparison of long-and short-axis imaging for in-plane ultrasound-guided femoral perineural catheter insertion. J Ultrasound Med. 2013;32:149–56.

    PubMed  Google Scholar 

  24. Tsui BC, Ozelsel TJ. Ultrasound-guided anterior sciatic nerve block using a longitudinal approach: “expanding the view”. Reg Anesth Pain Med. 2008;33:275–6.

    PubMed  Google Scholar 

Download references

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.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA

    Christopher A. J. Webb, T. Edward Kim, Natasha Funck, Steven K. Howard, T. Kyle Harrison, Toni Ganaway & Edward R. Mariano

  2. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, 3801 Miranda Avenue (112A), Palo Alto, CA, 94304, USA

    Christopher A. J. Webb, T. Edward Kim, Natasha Funck, Steven K. Howard, T. Kyle Harrison, Heidi Keng & Edward R. Mariano

Authors
  1. Christopher A. J. Webb
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Edward Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Natasha Funck
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steven K. Howard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Kyle Harrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toni Ganaway
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Heidi Keng
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Edward R. Mariano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Edward R. Mariano.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Webb, C.A.J., Kim, T.E., Funck, N. et al. Comparison of catheter tip migration using flexible and stimulating catheters inserted into the adductor canal in a cadaver model. J Anesth 29, 471–474 (2015). https://doi.org/10.1007/s00540-014-1957-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00540-014-1957-9

Keywords

Search

Navigation