This document discusses the rationale for using stimulating versus non-stimulating catheters for continuous peripheral nerve blocks and summarizes the current evidence. It describes how stimulating catheters can help ensure correct placement but studies have shown inconsistent results. Ultrasound guidance has been shown to decrease placement time and failures compared to electrical stimulation techniques alone. While stimulating catheters may provide slightly better analgesia when correctly placed, ultrasound guidance is a good alternative approach. In conclusion, more research is still needed to definitively determine the advantages of different catheter placement techniques.

1. Peripheral Nerve Catheters; Stimulating Versus Non stimulating An Evidence Based Approach Nabil M Elkassabany MD MSCE Assistant Professor Director; Orthopedic Anesthesia Section Department of Anesthesiology and Critical Care University of Pennsylvania Health System

4. Continuous perineural analgesia versus systemic opioids A meta-analysis published in 2006 (19 RCTs with 603 patients) compared continuous perineural analgesia versus mixed systemic opioids (13 of 19 RCTs used IV PCA) Richman JM, et al. Anesth Analg 2006;102:248–57 Perineural analgesia, which can be used on an ambulatory basis, provided statistically superior analgesia at rest and with activity for 48–72 h with a reduction in risk of nausea, sedation, pruritus but increased risk of motor block. Clinically superior analgesia was apparent at rest for the first24 h and with activity for the first 48 h. Ilfeld BM, Enneking FK. Et al: Anesth Analg 2005;100:1822–33 Summary statement: Meta-analysis indicates that continuous perineural analgesia provides clinically superior analgesia for up to 48 h after surgery with reduced side effects when compared with systemic opioids.

6. CONCLUSIONS: SSFNB or continuous FNB (plus PCA) was found to be superior to PCA alone for postoperative analgesia for patients having total knee arthroplasty. The impact of adding a sciatic block or continuous FNB to a SSFNB needs to be studied further.

7. Non Stimulating Catheres

10. Stimulating Catheter Placement

11. The Catheter www.Raeducation.com

12. The Needle www.Raeducation.com

13. The Snap Lock www.RAeducation.com

14. Catheter placement

15. Catheter placement ( cont)

16. Catheter placement ( cont)

19. Tunneling ( technique)

20. Tunneling ( technique)

26. Evidence for ultrasound placed catheter versus stimulating catheters

27. US guided catheter insertion

30. CONCLUSION: For popliteal-sciatic perineural catheters, ultrasound guidance takes less time and results in fewer placement failures compared with stimulating catheters. However, analgesia may be mildly improved with successfully placed stimulating catheters.