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Connective Tissue Oncology Society |
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| 2001 CTOS Annual Meeting Posters— Surgery REGIONAL
POSTOPERATIVE ANALGESIA VIA INDWELLING EPINEURAL CATHETERS FOLLOWING
MAJOR LIMB SPARING RESECTIONS AND AMPUTATIONS: ANALYSIS OF 166 PATIENTS OBJECTIVE: Continuous postoperative administration of local anesthetics through epineural catheters (surgically implanted within a peripheral nerve sheath, or epineural space) is a novel technique for obtaining regional pain control developed by the senior author over a decade ago. The purpose of this study was to document the safety, efficacy, and reliability of this technique used at a single institution. METHODS: Retrospective analysis of 166 pts (median age 45.8 yrs, 86 male/81 female) undergoing limb-saving resection (119), amputation (31), or other major surgical procedure (16) who were implanted with one or more epineural catheters prior to wound closure. Actual nerves implanted with catheters included: sciatic (110), femoral (38), brachial plexus (29), tibial (11), peroneal (7), lumbosacral plexus (4), obturator (2), median (2), ulnar (1), and tarsal tunnel (1). Following implantation, each catheter was bolused with 10 cc of 0.25% bupivacaine (Marcaine) to achieve an initial block, then continuously infused with bupivacaine for a minimum of 24 hours to a maximum of 21 days post-operatively. 112 pts had complete medication records and were divided into groups: Group 1 pts (34) received an epineural catheter, PCA pump, and a lumbar epidural catheter (triple modality pain control), while Group 2 pts (78) received only an epineural catheter and PCA pump (dual modality pain control). The total amount of narcotics used postoperatively (expressed in mg equivalents of IV morphine), and the verbal mean pain rating (MPR) were recorded. RESULTS: Average MPR and total narcotic use for Group 1 was 2.9 and 320 vs. 3.2 and 240 for Group 2. There were no local complications, i.e. infections, hematomas, or residual neurologic losses, attributable to the implantation or use of epineural catheters. 3 catheters broke at the skin level while being removed; 2 of these catheter tips were removed at bedside while 1 was left in situ. 3 catheters were unintentionally pulled out as a result of pt movement. One patient inadvertently died following unintentional infusion of a marcaine dosage though an IV line instead of the catheter. CONCLUSION: (1) The use of epineural catheters following limb sparing or ablative surgery provides dramatic postoperative analgesia comparable to that seen in pts with epidurals. (2) This technique is simpler, safer and more reliable than epidural catheters without any risk for epidural hematoma, abcess, or spinal leak, particularly in pts who have recently received chemotherapy. (3) We recommend epineural catheters as a primary mode of postoperative pain control following major resections and amputations at the pelvic, shoulder girdle level as well at the hip and knee joint.
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