The effect of stimulating versus nonstimulating catheter techniques for continuous regional anesthesia: a semiquantitative systematic review

Abstract

Background and objectives: Stimulating catheters provide feedback regarding the location of the catheter tip in relation to the target nerve or plexus. There is debate concerning whether stimulating catheters may reduce the failure rate of postoperative analgesia or whether they may enhance functional recovery by providing superior and more reliable postoperative analgesia.

Methods: Studies comparing the effect of stimulating versus nonstimulating catheters for postoperative analgesia were systematically and independently searched by 2 authors.

Results: Eleven randomized controlled studies could be included in this review. One trial was performed in volunteers; the others were clinical trials in patients. Five trials were performed in patients scheduled for a femoral nerve catheter, 4 for a distal sciatic nerve catheter, 1 in patients receiving an interscalene nerve catheter, and 1 in patients with an infraclavicular brachial plexus block. A standard quantitative analysis was deemed inappropriate because of considerable heterogeneity regarding the investigated outcome parameters. A semiquantitative review revealed that efficacy (judged by reduction in the need for rescue analgesics, complete surgery block, or median effective local anesthetic volume blocking the nerve) suggests improvement in stimulating catheters compared with nonstimulating catheters. Patient satisfaction as well as functional recovery was poorly investigated, so no conclusions could be drawn.

Conclusions: Published reports of randomized controlled trials provide evidence for a better analgesic effect from stimulating catheters. Future trials should be conducted in a standardized manner with uniform reporting of outcomes, which may facilitate future quantitative analysis.