Continuous Perineural Catheters for Postoperative Pain From an Ambulatory Surgery Center

To the Editor: The recent article describing the incidence of unplanned health care utilization after wrist surgery by Sunderland et al broaches an important aspect of regional anesthesia that is often ignored or missed. It is not surprising to see that the unplanned health care utilization rate is higher for patients with single-shot brachial plexus blocks (sBPBs) versus patients receiving general anesthesia alone. In the discussion, the authors raise the important issue of single-shot versus continuous brachial plexus blocks. One could argue that unless there is a contraindication, such as active infection or anticoagulation, every patient should receive a continuous catheter. As the article notes, wrist surgery is very painful. We as anesthesiologists are doing patients a service by avoiding general anesthesia, but we may be doing them a disservice by limiting the regional anesthetic to a single-injection technique. Postoperative pain is typically expected to extend beyond the duration of a typical singleshot nerve block. Thus, why do many patients not receive a continuous technique to extend pain control? Many potential reasons can be deduced. To begin, placing an sBPB takes significantly less time and skill than placing a peripheral nerve catheter. In a busy ambulatory surgery center, the extra time needed to place a catheter is often not available. Furthermore, placing and managing peripheral nerve catheters are a skill set that is inconsistent among anesthesiologists, a reality that may generate quality assurance