Subcutaneous tunnelling of pediatric peripheral nerve block catheters: a novel technique to minimize catheter damage
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Subcutaneous tunnelling of pediatric peripheral nerve block catheters: a novel technique to minimize catheter damage Wataru Sakai, MD . Tomohiro Chaki, MD, PhD . Shunsuke Tachibana, MD, PhD . Yuko Nawa, MD, PhD . Michiaki Yamakage, MD, PhD
Received: 28 July 2020 / Revised: 3 September 2020 / Accepted: 8 September 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, The use of continuous peripheral nerve block (PNB) techniques in pediatric patients is associated with two drawbacks. First, the block catheter is often too close to the surgical site, which is a deterrent to its use. Second, adequate catheter fixation is difficult because children tend to move and sweat more and, when combined with the relatively shallow catheter embedment depth, this can lead to local anesthetic leakage. Moreover, the adhesive tape often cannot adequately fix the catheter to pediatric skin (especially neonatal). Thus, unstable fixation of the catheter leads to unstable analgesia, drug leakage, and the need for frequent changes of the adhesive tape. At our institution, subcutaneous tunnels are used during continuous erector spinae plane blocks in patients undergoing biliary atresia surgery or right thoracotomy for atrial septal defect, and with continuous femoral and sciatic nerve blocks used for pediatric limb lengthening Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-020-01807-0) contains supplementary material, which is available to authorized users. W. Sakai, MD (&) Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan e-mail: [email protected] Department of Anesthesiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan T. Chaki, MD, PhD Y. Nawa, MD, PhD Department of Anesthesiology, Hokkaido Medical Center for Child Health and Rehabilitation, Sapporo, Hokkaido, Japan S. Tachibana, MD, PhD M. Yamakage, MD, PhD Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
procedures. Clinically, we consider that subcutaneous tunnelling is the only way to overcome the above issues. Nevertheless, because of the small size of the equipment used in pediatric patients, it is difficult to perform subcutaneous tunnelling without causing catheter shear or breakage and other needle-related injuries. Herein, we introduce a simple and safe method of subcutaneous tunnelling for continuous PNB in pediatric patients that involves a ‘‘railroading’’ technique. This tunnelling technique requires a 5- or 8-cm long 19-G pediatric epidural needle with a stainless-steel stylet (Hakko Co. Ltd., Tokyo, Japan), and a long 20-G intravenous (IV) catheter (with the needle removed), the length of which determines the length of the subcutaneous tunnel. We usually use a 51-mm 20-G IV needle (TERUMO, Tokyo, Japan), which allows the creation of a 3–5-cm subcutaneous tunnel. After completing the PNB using a 19-G 5- or 8-cm long pediatric epidural n
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