Regional anaesthesia using peri neural catheters

You have been given a continuous peri neural local anaesthetic catheter to give you pain relief after your operation. This guidance sheet will give you further information about it.

A peri neural catheter is a long, thin, floppy tube that has been positioned to lie next to the nerve that supplies strength and feeling to the limb or area you have had your operation on. You may have one or two of these catheters. The catheter is attached to a specialised pump that delivers local anaesthetic through the catheter to numb the nerve continuously. The purpose of a continuous peri neural catheter is to provide pain relief to the operation site by reducing sensation.

• A peri neural catheter should give you good, continuous pain relief.
•  You should need to take fewer painkillers whilst the peri neural catheter is in place, so you can reduce side effects from strong pain killers such as nausea, constipation and drowsiness.
• It may be more comfortable to move or take part in physiotherapy.

• The catheter may move away from the nerve or become kinked. The local anaesthetic may then not reach the nerves and may no longer be effective.
• Any foreign body or break in the skin is a potential focus of infection: precautions against infection are taken during insertion, and infection is uncommon. Should infection develop, it may need treatment with antibiotics.
• You may have some mild bruising around the insertion site; this is common and will resolve.
• Depending on where the peri neural catheter is placed, there may be localised side effects which will be explained to you. These will resolve when the effects of the local anaesthetic resolve.

Your anaesthetist will have explained how your peri neural catheter and pump work. The local anaesthetic can be given in different ways:

1. A continuous infusion of local anaesthetic to the nerve that supplies sensation to the limb you had your operation on. The amount of local anaesthetic may be able to be increased or decreased, depending on your discomfort.

or:

2. A continuous infusion of local anaesthetic to the nerve that supplies sensation to the limb you had your operation on PLUS the option of giving yourself a little more local anaesthetic by pressing a button attached to the pump, eg to achieve better pain relief in time for physiotherapy or having dressings changed.

A peri neural catheter will usually stay in place for 48 to 96 hours, but can stay for as long as 2 weeks. Once the peri neural catheter is inserted, it is not uncomfortable but the area where you had the operation will feel numb and heavy. It may also feel tingly and warm. If the peri neural catheter is for your arm, your arm will be kept in a sling for support. If the peri neural catheter is for your leg, you may need to be accompanied when walking as your leg may be weaker than normal.

Whilst you are on the ward, you and the catheter will be checked regularly to make sure it is working well. Once the peri neural catheter is removed or the local anaesthetic infusion stopped, it will take several hours for the sensation and power to the numbed area to return tonormal. You may need to start taking more oral painkillers if discomfort increases.

• Do not attempt to change the settings on the pumps yourself.
• Do take care of the pre programmed pump and catheter equipment as the nerve catheter may become dislodged.
• Keep the insertion site and catheter equipment clean and dry.
• Do take care and ask for help before walking with a numb leg.