Dermabond Decreases Pericatheter Local Anesthetic Leakage After Continuous Perineural Infusions

To the Editor Continuous perineural infusions (CPNIs) of local anesthetic provide sustained postoperative analgesia, opioid sparing, and facilitate early discharge from the hospital.1 One common problem with CPNIs is pericatheter leakage that can compromise the sterile dressing, increase the risk of dislodgement of the perineural catheter,1 and, as a result, decrease patient satisfaction. Frequent dressing changes are also associated with increased risk of perineural catheter insertion site colonization and infections.2 One technique described in a case series to secure the CPNI catheters is using 2-octyl cyanoacrylate glue (Dermabond® Topical Skin Adhesive; Ethicon, Somerville, NJ) to secure the site of the continuous peripheral nerve block catheter.3 The sterile liquid once applied to the skin polymerizes within minutes, forming a waterproof bond with the keratin in the epidermis. Since August 2008, we have applied Dermabond at the CPNI insertion site after catheter placement and before injecting a bolus of local anesthetic. After injection of local anesthetic, we place a sterile transparent dressing over the Dermabond-catheter complex at the catheter entry site. We provide written instructions to the family and a member of the nursing staff explains the process to the family. Most of the CPNI catheters are removed by a family member on postoperative day 2 at home. We also explain to the family that we use Dermabond, which may be associated with increased resistance when catheter withdrawal is attempted. However, we have had no problems related to removal of the catheters. We compared the incidence of local anesthetic leakage and CPNI catheter dislodgement between CPNI catheters placed before using Dermabond and those after using Dermabond. In 896 patients in whom catheters had been implanted and the injection site sealed with Dermabond, a leak occurred in 5 cases (0.56%) resulting in removal of 3 catheters (0.33%) because of leakage, and in 8 cases (0.89%), the catheters dislodged spontaneously before the planned removal. When Dermabond was not used (before August 2008), of the 748 patients, a leak occurred in 29 cases (3.87%) of which 9 (1.2%) were removed because of heavy leakage, and in 26 cases (3.48%), the catheters dislodged before the planned removal. These data suggest that Dermabond may be useful in preventing pericatheter leakage and may also reduce the incidence of premature dislodgement of the catheter. Harshad Gurnaney, MBBS, MPH F. Wickham Kraemer, MD Arjunan Ganesh, MBBS Department of Anesthesiology and Critical Care Medicine The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine Philadelphia, Pennsylvania [email protected]