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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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PEARLS

Appropriate sedation is key during placement of a continuous peripheral block catheter. A continuous technique typically has a slightly longer duration than a single-injection block, and it may cross more fascial planes than when a single-injection method is used. Appropriate infiltration of local anesthetic at the site of the block and at the site of tunneling is also important and should not be rushed. While making adjustments in needle position when establishing the initial optimum catheter position, take care that the tip of the catheter is inside the shaft of the needle prior to needle manipulation. Because continuous catheters are often left in place for an extended time, adherence to aseptic technique is required. After catheter placement, the site should be covered with a transparent dressing to enable daily inspection of the catheter exit site and skin bridge area; this technique allows direct inspection for signs of inflammation.

Often the entire limb is insensitive for the duration of the continuous block, so vulnerable nerves should be specifically protected. They include the ulnar nerve at the elbow, the radial nerve at the mid-humeral level, and the common peroneal nerve at the fibular head area. Ambulatory patients with a continuous brachial plexus block in place should always use a properly fitted arm sling to preventtraction injury to the brachial plexus or injury to the radial nerve by the sling.

When removing the catheter, it is ideal to withdraw it after full limb sensation has returned. Radiating pain experienced during removal of catheter may indicate that the catheter is intertwined with a nerve or nerve root. Surgical removal of catheters after fluoroscopic examination may be indicated if the radiating pain persists with removal attempts, but this is rarely required.

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