Home peripheral nerve catheters: the first 24 months of experience at a children’s hospital

Andrew Gable,1,2 Candice Burrier,1,3 Jenna Stevens,1 Sharon Wrona,1 Kevin Klingele,4,5 Tarun Bhalla,1,3 David P Martin,1,3 Giorgio Veneziano,1,3 Joseph D Tobias1,3 1Department of Anesthesiology and Pain Medicine, Nationwide Children’s Hospital, Columbus, 2Heritage College of Osteopathic Medicine, Ohio University, Athens, 3Department of Anesthesiology and Pain Medicine, The Ohio State University, 4Department of Orthopedics, Nationwide Children’s Hospital, 5Department of Orthopedics, The Ohio State University, Columbus, OH, USA Context: Home peripheral nerve catheters (PNCs) have become common practice for adult patients after major orthopedic surgery. However, use in pediatric patients is a recent application.Objectives: The purpose of this study was to review the demographics and outcomes of pediatric patients receiving a PNC at our institution.Methods: This retrospective study included patients from October 2012 through October 2014 undergoing orthopedic procedures with a PNC placed for postoperative pain management.Results: A total of 118 patients aged 3.2–25.3 years were identified. The types of catheters included femoral (80.5%), interscalene (11.9%), sciatic (5.9%), and supraclavicular (1.7%). The majority of patients were discharged to home on the day of surgery (77.1%). In the postanesthetic care unit, the average pain score was 2.5, the incidence of nausea/emesis was 5.9%, and the need for opioid administration was 50.8%. There were no major complications. Minor complications included a 7.6% rate of early catheter removal with 5.9% of those due to catheter leakage and an unsecure dressing. There was one case of metallic taste in the mouth without other symptoms of local anesthetic toxicity that resolved without further complication.Conclusion: The implementation of a home PNC program in pediatric patients at our institution has been highly successful with a high rate of ambulatory catheters, low pain scores, low rates of nausea and vomiting, and no serious complications. Minor complications included leaking of the catheter and early discontinuation of the catheter. Keywords: peripheral nerve catheter, pediatric, regional anesthesi