It’s a pleasure to begin this journal club with an outstanding article from my own group here at The Children’s Hospital of Philadelphia. Several years ago, they began inserting continuous peripheral nerve catheters (CNPB) in children undergoing orthopedic procedures. These children were then discharged home (usually the same day) with the nerve catheter attached to a source of local anesthetic solution, with the goal of attaining pain relief over the first several days. When the local anesthetic was depleted, the child’s parent would pull out the catheter. The article is noteworthy because of the large size (n = 1,285) of the numbers of patients included in the analysis. All patients received intraoperative infusion of ropivacaine,  followed by postoperative infusion of either ropivacaine or bupivacaine. Nurses or physicians assigned to the acute pain service contacted all patients by telephone once or twice daily following discharge to document efficacy and complications.

The results were outstanding: The mean duration of the CPNB was 50.7 ± 14.4 hours (mean ± SD). Among patients discharged home with the CPNBs, 969 (75.4%) of the patients required either no supplemental opioids or oral opioids only on an “as needed” basis in the postoperative period (confidence interval, 73.0%–77.8%). Two patients were readmitted for IV pain management after they were discharged home with the CPNB catheters. No neurological deficit related to the CPNBs was identified in any of the patients at their 6-month follow-up with the orthopedic surgeon (confidence interval, 0%–0.29%).

A list of complications are described in Table 3: