REVIEW ARTICLE Continuous Peripheral Nerve Blocks at Home: A Review Brian M. Ilfeld, MD, and F. Kayser Enneking, MD From the Departments of Anesthesiology and Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida Postoperative analgesia is generally limited to 12–16 h or less after single-injection regional nerve blocks. Postoper- ative analgesia may be provided with a local anesthetic infusion via a perineural catheter after initial regional block resolution. This technique may now be used in the outpatient setting with the relatively recent introduction of reliable, portable infusion pumps. In this review article, we summarize the available published data related to this new analgesic technique and highlight important issues related specifically to perineural infusion provided in pa- tients’ own homes. Topics include infusion benefits and risks, indications and patient selection criteria, catheter, infusion pump, dosing regimen, and infusate selection, and issues related specifically to home-care. (Anesth Analg 2005;100:1822–33) I n the past decade, there has been an increasing inter- est in “continuous peripheral nerve blocks,” also called “perineural local anesthetic infusions.” This technique involves the percutaneous insertion of a cath- eter directly adjacent to the peripheral nerves supplying an affected surgical site (as opposed to a “wound” cath- eter placed directly at a surgical site). Local anesthetic is then infused via the catheter providing potent, site- specific analgesia. Combining a perineural catheter with a portable infusion pump, outpatients may theoretically experience the same level of analgesia previously af- forded only to those remaining hospitalized. A previous review article (1) of perineural infusion for inpatient analgesia concluded, “whether this technique is effective for ambulatory patients remains to be determined.” Sub- sequently, a plethora of data regarding continuous pe- ripheral nerve blocks in outpatients has been published. In this review, we summarize this new evidence, and highlight important issues related specifically to peri- neural local anesthetic infusion provided at home. Infusion Benefits Although continuous regional blockade was first de- scribed more than 50 yr ago (2), it was not until 1998 that the introduction of lightweight, portable infusion pumps made home infusion possible (3). Subse- quently, case reports or series of ambulatory perineu- ral infusion were described via peripheral nerve cath- eters in various locations including paravertebral (4), interscalene (5–7), intersternocleidomastoid (8), infra- clavicular (6), axillary (9), psoas compartment (9,10), femoral (9,11), fascia iliaca (5), sciatic/Labat (9,10), sciatic/popliteal (6,12), and tibial nerve placement (6). Ambulatory continuous peripheral nerve blocks in pediatric patients have also been reported in patients as young as 8 yr of age (13). However, the first pro- spective evidence of infusion benefits was not re- ported until a randomized, double-masked, placebo- controlled investigation was published in 2000 (14). This study by Klein et al. involved 40 subjects un- dergoing open rotator cuff repair who received an interscalene block and perineural catheter preopera- tively and were randomized to receive either perineu- ral ropivacaine 0.2% or normal saline postoperatively (10 mL/h). Patients receiving perineural ropivacaine averaged a score of 1 on a visual analog pain scale of 0 –10 compared with a 3 for subjects receiving placebo. Although a pump designed for ambulatory infusion was used, patients remained hospitalized during local anesthetic infusion, and health care providers re- moved all catheters before home discharge. Because patients remained hospitalized, the investigators “felt compelled to provide more than oral analgesics,” and patients had access to IV morphine via patient- controlled analgesia (PCA) (14). Therefore, patients Supported, in part, by the Department of Anesthesiology, Uni- versity of Florida, Gainesville, Florida. All of the catheter manufacturers and pump distributors noted in this article have donated product for research purposes to the authors. The following companies have provided research funding to Dr. Ilfeld for various investigations: Arrow International, B. Braun Medical, Deltec (Smiths Medical) and Stryker Corporations, and AstraZeneca Pharmaceuticals. These companies had no input into any aspect of the preparation of this manuscript. Dr. Ilfeld has previously performed consulting work for Arrow International. Accepted for publication November 10, 2004. Address correspondence and reprint requests to Brian M. Ilfeld, MD, Department of Anesthesiology, PO Box 100254, 1600 SW Ar- cher Road, Gainesville, FL 32610 – 0254. Address e-mail to bilfeld@ ufl.edu. DOI: 10.1213/01.ANE.0000151719.26785.86 ©2005 by the International Anesthesia Research Society 1822 Anesth Analg 2005;100:1822–33 0003-2999/05