ED placement of perineural catheters for femoral fracture pain management

Regional nerve blocks provide superior analgesia over opioid-based pain management regimens for traumatic injuries such as femur fractures. An ultrasound-guided regional nerve block is placed either as a single-shot injection or via a perineural catheter that is left in place. Although perineural catheters are commonplace in the perioperative setting, their use by emergency physicians (EPs) for emergency pain management in adults has not been previously described. Perineural catheters allow prolonged and titratable delivery of local anesthetic directly targeted to the injured extremity, resulting in opioid sparing while maintaining high-quality pain relief with improved alertness. Despite these advantages, most EPs do not currently place perineural catheters, likely due to the widespread perception that the procedure is both excessively time consuming and too technically difficult to be practical in a busy emergency department (ED). A catheter-over-needle kit, resembling a peripheral intravenous line, is now available and may be familiar to EPs than traditional catheter-needle assemblies. Recent studies also suggest excellent analgesic outcomes with intermittent perineural bolusing of local anesthetic, thereby dispensing with the need for complex and expensive infusion pumps. Herein, we describe our successful placement of perineural femoral catheters at a busy inner-city public hospital ED. Our experience suggests that this is a promising new technique for emergency pain management of acute extremity injuries.