Regional Anaesthesia Using Perineural Catheters

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General Information

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

What is a continuous perineural catheter?

A perineural catheter is a long, thin, floppy tube that has been positioned to lie near the nerve or nerves that supply strength and feeling to the area of your body that is painful or had surgery. 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 or nerves continuously. The purpose of a continuous perineural catheter is to provide pain relief to the painful site by reducing sensation.

What are the benefits?

• A perineural catheter should give you good, continuous pain relief
•  You should need to take fewer painkillers whilst the perineural 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

What are the risks?

• 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 perineural 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
• If local anaesthetic is directly absorbed into the circulation, you may experience signs of toxicity, such as tingling in your hands and lips, dizziness, arrhythmias or loss of consciousness. Using ultrasound to visualise the injection reduces this risk.

How does the perineural catheter work?

Your anaesthetist will have explained the benefit and risks of the catheter to you. The infusion of local anaesthetic is driven by a pump which can work in different ways:

• A continuous infusion, more typically for pain in upper or lower limbs
• A regular bolus given by the pump, more typically for pain from muscle planes or broken ribs
• A bolus activated by the patient with a special handset. This may be suggested to you in certain situations.

What happens next?

A perineural catheter will usually stay in place for 48 to 96 hours, but can stay for as long as 2 weeks. Once the perineural 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 perineural catheter is for your arm, your arm will be kept in a sling for support. If the perineural 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 perineural 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 to normal. You may need to start taking more oral painkillers if discomfort increases.

Please be aware of the following advice:

• 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

Do inform your nurse if:

• You have pain in the affected limb
• You cannot move the affected limb at all
• The pump alarms
• The nerve catheter becomes disconnected
• There is any leakage from the nerve catheter
• You notice redness or swelling around the catheter insertion site
• You think you may have side effects from the local anaesthetic
• You experience any dizziness, tingling in the lips, blurred vision or feel unwell
• You have any concerns

Any problems?

Please speak to the team looking after you if you have questions or concerns.

Contact details

If you have any concerns once you are home, please contact the hospital where you had the operation:

More information:

You will find more information about nerve blocks on these websites:

Royal College of Anaesthetists for patients and relatives.