Continuous peripheral nerve block catheter infections in combat-related injuries: a case report of five soldiers from Operation Enduring Freedom/Operation Iraqi Freedom.

ABSTRACT

DESIGN: Case series. SETTING: Military medical facility providing acute care for soldiers injured while fighting in the war in Iraq and Afghanistan. OBJECTIVE: To report a series of infections related to use of continuous peripheral nerve catheters for postoperative pain control in the military polytraumatic setting. The analysis of the above infections includes similarities and differences in infection patterns and attempts to clarify possible risk factors for such infections to include duration of catheter placement, type of catheter, preprocedural antibiotics, and tunnel vs nontunneled catheters. The goal of this analysis is to assist in the development of protocols that may prevent future catheter infections. METHODS: Clinical data were obtained from five previously healthy male soldiers receiving acute care at Brooke Army Medical Center using continuous peripheral nerve catheters for postoperative pain for multiple and frequent procedures. RESULTS: In a total of six catheter infections, two were noted to have superficial skin infections while four were shown to have deep tissue involvement confirmed by imaging studies. All patients were started on initial or additional antibiotics after catheter removal. Three catheter infections, all with stimulating catheters, required surgical irrigation and debridement in the operating room. CONCLUSIONS: Continuous peripheral nerve catheters are not without complications and risks including infection. Duration of catheter use was the most significant factor with the development of a catheter-related infection in our series. This series also highlights how stimulating and nonstimulating catheter infections may present differently, as stimulating catheters may have a greater tendency to present as deep space infections with minimal superficial findings.