title: Continuous peripheral nerve block in combat casualties receiving low-molecular weight heparin.
abstract: BACKGROUND
  Continuous peripheral nerve block (CPNB) is an important therapeutic tool in the anaesthetic and analgesic management of combat casualties at Walter Reed Army Medical Center (WRAMC). We describe our experience using CPNB techniques in combat trauma patients treated with low-molecular weight heparin (LMWH). Guidelines used at our institution for managing CPNB catheters in patients being treated with LMWH are introduced.
  
  
  METHODS
  From March 2003 to April 2005, 187 combat casualties treated by the WRAMC regional anaesthesia/acute pain section using CPNB were evaluated retrospectively by electronic chart review. Patient characteristic data, CPNB type, duration of CPNB, indication for LMWH [enoxaparin sodium injection (Lovenox-Sanofi Aventis, Bridgewater, NJ, USA)], enoxaparin dose (mg) before and after catheter insertion and removal, time from CPNB placement and removal to enoxaparin dose, and complications were recorded.
  
  
  RESULTS
  Median enoxaparin dose and time given before catheter insertion were 30 mg and 21 h, respectively. Median enoxaparin dose was also 30 mg given a median of 12 h after peripheral nerve catheter placement. Catheters remained in situ for a median of 8 days (range 1-33 days). Catheter specific complications were infrequent and identified in 7 (3.7%) patients (two catheter malfunction-kinking, catheter tip dislodgement in situ, two superficial catheter site infections and two catheter dislocations). There were no catheter-related bleeding complications evident in this study.
  
  
  CONCLUSIONS
  Information regarding the safety of CPNB in patients treated with LMWH for perioperative venous thromboembolism prevention is scarce. Our initial experience with CPNB and concurrent LMWH has not been complicated by catheter-related bleeding.
authors.affiliation: Army Regional Anesthesia and Pain Management Initiative, Anesthesia and Operative Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. chester.buckenmaier@na.amedd.army.mil
authors.forename: C C
authors.initials: CC
authors.lastname: Buckenmaier
authors.forename: C H
authors.initials: CH
authors.lastname: Shields
authors.forename: A A
authors.initials: AA
authors.lastname: Auton
authors.forename: S L
authors.initials: SL
authors.lastname: Evans
authors.forename: S M
authors.initials: SM
authors.lastname: Croll
authors.forename: L L
authors.initials: LL
authors.lastname: Bleckner
authors.forename: D S
authors.initials: DS
authors.lastname: Brown
authors.forename: A
authors.initials: A
authors.lastname: Stojadinovic
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage* / Q000627:therapeutic use; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007493:Iraq; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D010525:Peripheral Nerves; D011183:Postoperative Complications / Q000517:prevention & control; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013923:Thromboembolism / Q000517:prevention & control; D020246:Venous Thrombosis / Q000517:prevention & control; D014857:Warfare; D014947:Wounds and Injuries / Q000601:surgery*
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin