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Perineural Catheter Techniques

Perineural catheter techniques are used to provide sustained analgesia that is beyond the duration of a single-injection peripheral nerve block (PNB). In the last 10 years they have become increasingly important for postoperative analgesia because of their localized profound analgesia and the ability to avoid adverse effects of both epidural techniques and intravenous opioid analgesics. The first case of perineural catheter insertion and use was described more than 50 years ago. Since then, the literature has consistently shown that continuous PNBs (CPNB) provide better analgesia than systemic opioid-based analgesia for the upper and lower limb surgery. Perineural catheters are commonly used in the inpatient setting and with the introduction of lightweight, reliable portable infusion pumps, they are being increasingly used for the outpatients. Potential benefits of CPNB include fewer side effects from systemic opioids, greater patient satisfaction, and faster functional recovery after surgery. Ambulatory CPNB have the potential to reduce length of hospital stay and inpatient costs. Evidence continues to be built as to optimal patient selection and surgical procedures for this modality.