Continuous sciatic nerve infusion: Expanded case report describing a new approach

Background and Objectives. Severe pain following extensive reconstructive foot surgery is difficult to manage effectively. Sciatic nerve block provides excellent analgesia for a limited duration. I wanted to determine an approach to sciatic nerve block enabling an infusion of a local anesthetic for a prolonged period without loss of efficacy due to catheter displacement. Methods. Seventy-six consecutive sciatic nerve catheter placements—in 73 patients undergoing reconstructive foot surgery—were performed by four different approaches. Soft epidural catheters were found to be unsatisfactory—both for placement and for prolonged infusion. A firmer catheter, also capable of “through the catheter” nerve stimulation, was developed and proved to be satisfactory on both counts. Traditional approaches proved satisfactory for identifying the nerve but were unsatisfactory for prolonged infusion. A unique “in line” approach was developed to enable the insertion of the catheter along the course of the sciatic nerve, thus maintaining position for prolonged infusions. Results. According to predetermined criteria for success, only 64% of placements using traditional epidural catheters were successful, whereas the firmer catheter with “through the catheter” nerve stimulation was successful in 95% of placements. Conclusions. The described “in line” technique of continuous sciatic nerve infusion of a local anesthetic solution gives prolonged and effective analgesia following foot surgery.