for saphenous nerve block (letter). Reg Anesth Pain Med 1996;21:490. 5. Comfort VK, Lang SA, Yip RW. Saphenous nerve an- esthesia—A nerve stimulator technique. Can J Anaesth 1996;43:852-857. 6. Wassef MR. Use of nerve stimulators in search for optimal site of block needle point of entry (letter). Reg Anesth Pain Med 1996;21:491. 7. Urmey WF, Grossi P. Percutaneous Electrode Guid- ance: A noninvasive technique for prelocation of pe- ripheral nerves to facilitate peripheral flexus or nerve block. Reg Anesth Pain Med 2002;27:261-267. Accepted for publication November 21, 2002. doi:10.1053/rapm.2003.50023 Perineural Catheter Placement for a Continuous Nerve Block: A Single Operator Technique To the Editor: Local anesthetic infused via a perineural catheter pro- vides potent analgesia, decreases narcotic use and related side effects, and in some cases, improves surgical out- come. 1-3 However, the techniques published to date have described 2 practitioners working in concert to place the initial surgical block or perineural catheter. As Daniel C. Moore, M.D. has noted previously in this journal, it is very common for anesthesiologists to lack assistants in busy operating suites, and procedures that require a sec- ond “set of hands” may greatly limit practitioners’ ability to perform them in a timely fashion, or even at all. 4 We would like to describe a technique that allows the place- ment of a surgical block and perineural catheter at any anatomical location with only a single operator. Following patient positioning, monitor application, premedication, and sterile preparation, a local anesthetic skin wheal is placed at the catheter insertion location. If an initial surgical block is desired, local anesthetic is pre- pared in syringes. A block tray/kit, which has been pre- viously described, is then opened using sterile technique (StimuCath; Arrow International, Reading, PA). 5 The nerve stimulator is placed on the gurney beside the op- erative extremity, the grounding electrode is applied to the patient, and the wire that will be attached to the stimulating needle is placed adjacent to the nerve stimu- lator (Fig 1A). The operator puts on sterile gloves for the remainder of the procedure. A clear drape with a central hole is used to cover the area, with the longer side used to cover the nerve stimulator. The conducting wire is connected to the nerve stimu- lator using the technique illustrated in Fig 1B, allowing the practitioner to retain glove sterility. The stimulating needle is then attached to the other end of the conducting wire and used to localize the nerve/plexus to be blocked. The nerve stimulator may be turned on and the current adjusted by the operator through the clear drape while remaining sterile (Fig 1C). Aspiration— usually requiring a second individual—is not performed as the needle has a stylet in place. Once the desired nerve/plexus is located, the stylet is removed and the catheter placed through the length of the needle. The conducting wire is then trans- ferred from the needle to the catheter, which has a con- ducting wire through its length, delivering current to its tip. The needle is held in place while the catheter is advanced 5 cm beyond the needle tip. The needle is then withdrawn over the catheter, the catheter tunneled (if desired), the injection port attached to the end of the catheter, and the conducting wire attached to the port, which allows confirmation of correct catheter tip place- ment. The catheter is then secured with sterile liquid adhesive and an occlusive dressing. The practitioner may then break sterility and, following negative aspiration, inject local anesthetic in divided doses to initiate the block. We hope that this method will Fig 1. A single operator technique for placing a perineural catheter for a continuous nerve block. (A) Equipment placement before sterile drape is placed, (B) connecting the conducting wire to the nerve stimulator while retaining sterility, and (C) adjusting the current during nerve/plexus localization without losing sterility. 154 Regional Anesthesia and Pain Medicine Vol. 28 No. 2 March–April 2003