1 Department of Anesthetics and Intensive Care, Rouen University Hospital, France. 2 Department of Orthopedic Surgery, Rouen University Hospital, France
* Corresponding author. E-mail: vincentcompere{at}hotmail.com
Accepted for publication April 29, 2005.
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Abstract |
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Keywords: anaesthetic techniques, regional, continuous ; complications, abscess
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Introduction |
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Case report |
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Postoperative analgesia was administered using a continuous popliteal infusion with ropivacaine 0.2% at an infusion rate of 7 ml h1 (infusor Baxter® with a volume of 250 ml). The infusor had a bacterial filter included into the system and the number of bag changes was limited to three. Five days after surgery, the catheter was removed. The nurse observed an area of superficial inflammation at the site of catheter insertion; there was no fever or pain. Fifteen days after the catheter was removed, the patient complained of pain in the thigh with fever. He had an elevated leukocyte count and increased C-reactive protein. Ultrasonography revealed a thigh mass (Fig. 1) and the abscess was treated by surgery. Copious amounts of pus subsequently indicated methicillin-resistant Staphylococcus aureus. The infection was treated with a 1-month course of antibiotics (vancomycin) with complete recovery.
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Discussion |
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In contrast, two studies have demonstrated that catheters inserted via the popliteal route are associated with a very low rate of bacterial colonization between 7.5% and 18.9%.7 8 This incidence is comparable with the low colonization rates observed for epidural or caudal catheters.9 Nevertheless, several case reports have described abscess formation after epidural catheterisation.10 11 Although S. aureus is the most common causative organism cultured from epidural4 10 11 or psoas abscess,4 it was not the most common organism isolated from peripheral analgesic catheters6 7 and it has been generally regarded as a pathogen of clinical significance. To our knowledge, this is the first case report to describe a severe infectious complication following a continuous popliteal nerve block. The abscess may have resulted from catheter colonization at the skin entry site and subsequently transmitted the infection from the skin to the thigh as previously suggested by Adam and co-workers for a psoas abscess complicating femoral nerve block.4 No risk factor for increased rate of infections such as diabetes mellitus or immunosuppression was present in this patient.
The duration of catheter use of 5 days in this case may also have played a role in the genesis of thigh abscess. In fact, this is the maximum duration which is reported in the literature.6 It is also possible that the longer the duration of catheter placement the greater the risk of high level of bacterial catheter colonization and consequently the risk of further infection as reported for central venous line catheters.12 However, no data are available to date regarding this type of a mechanism for peripheral catheters used for continuous analgesia.
In conclusion, serious complications may rarely occur during continuous popliteal sciatic nerve block for postoperative analgesia. This case emphasizes the importance of adhering to strict aseptic technique and possibly of limiting the duration of catheter use. The authors emphasize the importance of using techniques that minimize the risk of bacterial contamination during both catheter placement and management of the infusion.
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Acknowledgments |
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References |
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