The Incidence of Falls at Home in Patients with Perineural Femoral Catheters: A Retrospective Summary of a Randomized Clinical Trial

To the Editor: We recently reported (1) on the analgesic outcomes of 233 randomized outpatients undergoing anterior cruciate ligament reconstruction, discharged home with a femoral perineural catheter in place. Patients and responsible family members were instructed (verbally and in writing) to not bear weight on the extremity in which the perineural catheter had been inserted. Four of these patients fell (1.7%): two while weight-bearing, one while non-weight-bearing (using crutches to go up stairs), and the other unknown. In three of these four patients, the infusion device was filled with levobupivacaine 0.25%; the other was filled with saline (placebo). All four patients had received a bolus of levobupivacaine (0.25%, 30 mL) before the perineural femoral catheter was inserted, per treatment group protocol. No sequelae resulted from these falls. Falls have been rarely reported in the literature after peripheral nerve blocks in outpatients. Klein et al. (2) reported one fall among 1791 patients (0.05%) who received single-injection nerve blocks with ropivacaine (the patient who fell had a femoral and sciatic block, and sustained no sequelae from the fall). We are not aware of any other studies reporting the incidence of falls in patients having received lower extremity nerve block(s), based on an OVID search (April 13, 2006) using keywords “nerve block,” “accidental fall,” “fall,” and “fell.” The incidence of falls at home (or in hospital) related to lower extremity blockade remains unknown, as does the incidence of falls at home after outpatient lower extremity surgery associated with patients experiencing moderate to severe pain (with no nerve blocks). Dr. B. Williams received financial support from National Institutes of Health/National Institute of Arthritis, Musculoskeletal, and Skin Diseases K23 AR47631, Bethesda, Maryland, United States; and International Anesthesia Research Society Clinical Scholar Research Award (2001), Cleveland, Ohio and additional support from the University of Pittsburgh Department of Anesthesiology. He has received honoraria from B. Braun USA (devices not used in this study) and has received unrestricted research funds from I-Flow Corporation (devices used in this study) and Arrow International (devices not used in this study). Brian A. Williams, MD, MBA Michael L. Kentor, MD Department of Anesthesiology Matthew T. Bottegal, BS Department of Orthopaedic Surgery UPMC South Side University of Pittsburgh Pittsburgh, PA [email protected]