Single shot vs continuous catheters

blocks local anaesthetic regionalanaesthesia Nov 03, 2025

One and done or keep it going? Single shot vs continuous regional infusions 💉

Regional blocks can be delivered as a single shot injection, or a perineural catheter can be placed to allow for an ongoing infusion of local anaesthetic for several days. Both are valuable tools for pain management 🏥, with choice dependant on:
🔹 Surgical factors and surgeon preference
🔹 Expected pain trajectory
🔹 Patient needs
🔹 Clinician experience

Single shot blocks are beneficial in that they:
🔸 Are quick to perform
🔸 Provide reliable intraoperative anaesthesia
🔸 Robust early postoperative analgesia
🔸 Lower procedural complexity and resource needs
🔸 Reduced infection risk

The benefits of continuous catheters include:
🔸 Extended analgesia duration
🔸 Reduced opioid consumption post operatively
🔸 Facilitates earlier rehabilitation
🔸 Titratable pain management

However, continuous catheters introduce additional nursing responsibilities and risks, such as:
🔹 Catheter dislodgment
🔹 Infusion pump management and programming
🔹 Increased risk of infection at catheter insertion site (often close to surgical site)
🔹 Catheter removal issues and considerations
🔹 Increased potential for cumulative LAST ⚠️

With this in mind, it’s important for perioperative nurses to ensure aseptic technique is maintained for insertion, adequate securement of perineural catheters, and clear documentation of the catheter including ongoing regional infusions. Ongoing management plans must be clearly handed over to ward staff, ensuring that referral to pain services has been completed for ongoing infusion monitoring and titration.

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References:

Australian and New Zealand College of Anaesthetists. (2014). Guideline for the management of major regional analgesia (PG03(A)) [PDF]. https://www.anzca.edu.au/getContentAsset/a70212ec-6074-4fa5-a62b-742f1f64523a/80feb437-d24d-46b8-a858-4a2a28b9b970/PG03%28A%29-Guideline-for-the-management-of-major-regional-analgesia-2014.PDF

Ilfeld, B. M. (2017). Continuous peripheral nerve blocks: An update of the published evidence and comparison with other modalities. Anesthesia & Analgesia, 125(4), 1259–1272. https://doi.org/10.1213/ANE.0000000000001581

Hutton, M. (2017). Regional anaesthesia and outcomes. Anaesthesia, 72(S1), 3–9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807931/

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