title: A pilot study to assess adductor canal catheter tip migration in a cadaver model.
abstract: An adductor canal catheter may facilitate early ambulation after total knee arthroplasty, but there is concern over preoperative placement since intraoperative migration of catheters may occur from surgical manipulation and result in ineffective analgesia. We hypothesized that catheter type and subcutaneous tunneling may influence tip migration for preoperatively inserted adductor canal catheters. In a male unembalmed human cadaver, 20 catheter insertion trials were divided randomly into one of four groups: flexible epidural catheter either tunneled or not tunneled; or rigid stimulating catheter either tunneled or not tunneled. Intraoperative patient manipulation was simulated by five range-of-motion exercises of the knee. Distance and length measurements were performed by a blinded regional anesthesiologist. Changes in catheter tip to nerve distance (p = 0.225) and length of catheter within the adductor canal (p = 0.467) were not different between the four groups. Two of five non-tunneled stimulating catheters (40 %) were dislodged compared to 0/5 in all other groups (p = 0.187). A cadaver model may be useful for assessing migration of regional anesthesia catheters; catheter type and subcutaneous tunneling may not affect migration of adductor canal catheters based on this preliminary study. However, future studies involving a larger sample size, actual patients, and other catheter types are warranted.
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Jody C
authors.initials: JC
authors.lastname: Leng
authors.forename: T Kyle
authors.initials: TK
authors.lastname: Harrison
authors.forename: Brett
authors.initials: B
authors.lastname: Miller
authors.forename: Steven K
authors.initials: SK
authors.lastname: Howard
authors.forename: Myles
authors.initials: M
authors.lastname: Conroy
authors.forename: Ankeet
authors.initials: A
authors.lastname: Udani
authors.forename: Cynthia
authors.initials: C
authors.lastname: Shum
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000772:Anesthesia, Local; D019645:Arthroplasty, Replacement, Knee; D002102:Cadaver; D057785:Catheters / Q000009:adverse effects*; D005548:Foreign-Body Migration / Q000473:pathology*; D006801:Humans; D010865:Pilot Projects; D013848:Thigh