• John J Finneran, Matthew W Swisher, Rodney A Gabriel, Engy T Said, Maryann U Abanobi, Wendy B Abramson, David J Dalstrom, Alexandra K Schwartz, William T Kent, Dongsheng Yang, Edward J Mascha, and Brian M Ilfeld.
• From the Departments of Anesthesiology (J.J.F., M.W.S., R.A.G., E.T.S., M.U.A., W.B.A., B.M.I.) Orthopedic Surgery (D.J.D., A.K.S., W.T.K.), University of California San Diego, San Diego, California Outcomes Research Consortium, Cleveland, Ohio (J.J.F., M.W.S., R.A.G., D.Y., E.J.M., B.M.I.) Department of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, Ohio (D.Y., E.J.M.).
• Anesthesiology. 2020 Apr 1; 132 (4): 854-866.

BackgroundThe basic perineural catheter design has changed minimally since inception, with the catheter introduced through or over a straight needle. The U.S. Food and Drug Administration recently cleared a novel perineural catheter design comprising a catheter attached to the back of a suture-shaped needle that is inserted, advanced along the arc of its curvature pulling the catheter past the target nerve, and then exited through the skin in a second location. The authors hypothesized that analgesia would be noninferior using the new versus traditional catheter design in the first two days after painful foot/ankle surgery with a primary outcome of average pain measured with the Numeric Rating Scale.MethodsSubjects undergoing painful foot or ankle surgery with a continuous supraparaneural popliteal-sciatic nerve block 5 cm proximal to the bifurcation were randomized to either a suture-type or through-the-needle catheter and subsequent 3-day 0.2% ropivacaine infusion (basal 6 ml/h, bolus 4 ml, lockout 30 min). Subjects received daily follow-up for the first four days after surgery, including assessment for evidence of malfunction or dislodgement of the catheters.ResultsDuring the first two postoperative days the mean ± SD average pain scores were lower in subjects with the suture-catheter (n = 35) compared with the through-the-needle (n = 35) group (2.7 ± 2.4 vs. 3.4 ± 2.4) and found to be statistically noninferior (95% CI, -1.9 to 0.6; P < 0.001). No suture-style catheter was completely dislodged (0%), whereas the tips of three (9%) traditional catheters were found outside of the skin before purposeful removal on postoperative day 3 (P = 0.239).ConclusionsSuture-type perineural catheters provided noninferior analgesia compared with traditional catheters for continuous popliteal-sciatic blocks after painful foot and ankle surgery. The new catheter design appears to be a viable alternative to traditional designs used for the past seven decades.

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