Dual lower extremity catheters

[deleted126335]

---

Members do not see this ad.

Had a really bad tib/fib fx he other day. Wound up putting in a popliteal catheter and single shot adductor canal block. Pt had significant pain in the saphenous distribution the next day. At the time I thought about putting in two lower extremity catheters. Couldn't think of a reason not to except I never saw it or heard about anyone doing it. So I backed off.

Anyone doing this?

 

[sevoflurane]

Had a really bad tib/fib fx he other day. Wound up putting in a popliteal catheter and single shot adductor canal block. Pt had significant pain in the saphenous distribution the next day. At the time I thought about putting in two lower extremity catheters. Couldn't think of a reason not to except I never saw it or heard about anyone doing it. So I backed off.

Anyone doing this?

Not anymore. But yes... def. ok to do. Tib-fibs hurt like stink.

 

[DRJ37]

In residency we would put in a femoral catheter plus a sciatic or popliteal catheter pretty frequently. You just have to watch what rate you turn them up to.

 

[okayplayer]

At my program (big regional trauma hospital with large volume LE surgery) we put in combo sciatic and saphenous PNCs probably a dozen times a day or so and have for many years. Typical infusions that we run are bupi 0.125% 8ml/h or ropi 0.2% 8ml/h.

 

[psychbender]

Had a really bad tib/fib fx he other day. Wound up putting in a popliteal catheter and single shot adductor canal block. Pt had significant pain in the saphenous distribution the next day. At the time I thought about putting in two lower extremity catheters. Couldn't think of a reason not to except I never saw it or heard about anyone doing it. So I backed off.

Anyone doing this?

Yes, all of the time. Fem/Sci catheters are very common in my trauma population (have not yet placed an adductor canal catheter). We commonly use 0.2% ropivacaine or 0.125% bupivicaine, and program the pumps for rate 8mL/hr, 4mL bolus, 20minute lockout.

 

[BLADEMDA]

Had a really bad tib/fib fx he other day. Wound up putting in a popliteal catheter and single shot adductor canal block. Pt had significant pain in the saphenous distribution the next day. At the time I thought about putting in two lower extremity catheters. Couldn't think of a reason not to except I never saw it or heard about anyone doing it. So I backed off.

Anyone doing this?

Give the Exparel vis the Adductor canal and your patient will be pain free for 72 hours with minimal to no motor block. Problem solved and no catheter required or needed.

If you are concerned about local "toxicity" reduce the Exparel to 80 mg or so per extremity/adductor canal block. This allows you to still run the Rop infusions for your popliteal catheters and not lose any sleep about peak local anesthetic blood levels.

 

[Idiopathic]

several pop/saph catheters for distal LE back in residency. also fem/sci catheters simultaneously

 

[deleted126335]

Not anymore. But yes... def. ok to do. Tib-fibs hurt like stink.

Why "not anymore"?

 

[sevoflurane]

Why "not anymore"?

No block room means I need to slam dunk 2 catheters once the patient hits the OR (No residents or CRNA's). As much as I'd like to think of myself as a ninja with the needle, it still takes time to properly place and secure 2 catheters- slowing down our rooms. If the fracture is severe enough, I will place a single catheter and add a single shot to the nerve that provides the least amount of analgesia. If we had more manpower, we would have a block room. We run a pretty lean ship at my shop at the moment. I'm prolly the only guy doing catheters (outside epidurals). That being said, a good single shot with decadron is pretty satisfying for non-weight bearing injuries.