Peripheral nerve block catheters for continuous nerve block have become an essential component of modern perioperative and acute pain management, offering prolonged and titratable analgesia that is particularly valuable for procedures associated with significant postoperative discomfort. A growing body of literature has evaluated the effectiveness, safety, and clinical considerations of nerve block catheters as their use extends to longer periods of time.
Nerve block catheters have significant analgesic advantages compared with single-injection nerve blocks in many cases, reducing postoperative pain scores, opioid consumption, and opioid-related side effects. Patients frequently report greater satisfaction and improved functional recovery during the period the catheters remain in place. The benefits are greatest during the first several postoperative days, and although the sustained advantage diminishes after catheter removal, perineural catheters remain the most reliable method of extended analgesia in settings such as orthopedic, trauma, and burn care where prolonged pain is anticipated.
Mechanical issues, however, pose challenges to extended catheter use. Catheter displacement, occlusion, and leakage are among the most common causes of functional failure of continuous nerve block, with risk increasing over time. Imaging-based evaluations show that displacement may occur more frequently than is apparent through clinical assessment alone, which may lead to breakthrough pain and increased opioid reliance. Enhanced fixation methods, standardized dressing techniques, and comprehensive patient education can mitigate these risks but do not eliminate them entirely.
Infection risk has historically limited catheter duration, with traditional recommendations favoring removal within 48–72 hours. More recent evidence has found that infection rates remain low even when nerve block catheters are maintained for extended periods of time. Studies in both adults and children report safe use beyond five days, with some cases extending up to two weeks without significant catheter-site infection. These findings support the safety of longer dwell times when appropriate aseptic technique, daily monitoring, and thoughtful patient selection are implemented. This expanded safety profile has meaningful implications for populations requiring prolonged postoperative or procedural analgesia.
Serious complications associated with prolonged catheter use are rare. Long-term neurological injury occurs at rates similar to those associated with single-injection blocks, and events such as vascular injury, hematoma, or local anesthetic systemic toxicity are infrequently reported.
Although continuous analgesia may theoretically mask early symptoms of compartment syndrome, documented instances remain scarce. Nevertheless, vigilance is essential, and clinicians must balance the benefits of prolonged analgesia with careful monitoring for neurovascular changes, signs of infection, and catheter malfunction.
Overall, the literature supports a nuanced, individualized approach to determining catheter duration rather than reliance on fixed time limits. Factors such as patient comorbidities, type of surgery, infection risk, anticipated analgesic needs, and the capability for close monitoring should guide clinical decision-making. When managed appropriately, perineural catheters provide reliable, high-quality analgesia with a favorable safety profile, making them an important modality across a wide range of surgical and clinical settings. Their evolving role reflects both improved understanding of their risk–benefit balance and continued advancements in catheter design and management practices.
References
1. Yoo S, Kim H, Kim J-T. Perineural catheters for continuous peripheral nerve blocks: a narrative review. Anesth Pain Med. 2025;20(1):5-13. DOI: 10.17085/apm.24192
2. Ilfeld BM, et al. Continuous peripheral nerve blocks for postoperative analgesia. Anesth Analg. 2008;106(1):187-200. DOI: 10.1097/EA9.0000000000000067
3. Sites BD, Brull R. Peripheral nerve catheters: A critical review of the efficacy. Reg Anesth Pain Med. 2019;44(4):435-444. DOI: 10.1016/j.bpa.2019.07.015
4. Perkins L, Pedroza G, Soghikian M, et al. Continuous peripheral nerve blocks for burn management: retrospective cohort. Reg Anesth Pain Med. 2024;rapm-2024-105930. DOI: 10.1136/rapm-2024-105930
5. Waxman JA, Reiss A, Chidambaran V, et al. Safety assessment of prolonged nerve catheters in pediatric trauma patients: a case series. Children (Basel). 2024;11(2):251. DOI: 10.3390/children11020251