Pain catheter

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A pain catheter is a thin plastic tube through which the patient is given pain medication. It is used, for example, after operations or for chronic pain. Here you can read everything you need to know about the pain catheter, how it is put on and what you need to consider when wearing one.

What is a pain catheter?

A pain catheter is a thin plastic tube that the doctor can use to administer numbing medication. It can be placed in close proximity to the spinal cord or remote from the spinal cord near a peripheral nerve. The pain catheter enables locally effective pain therapy.

Pain catheter close to the spinal cord

When it comes to procedures close to the spinal cord, a distinction is made between spinal catheters and epidural catheters. As its name suggests, the epidural catheter is located in the epidural space: This is a space filled with fat and connective tissue that surrounds the membranes of the spinal cord. If the anesthetic is released here, it must first spread to the nerve roots.

With the spinal catheter, on the other hand, the doctor injects the anesthetic directly into the liquor space, which is closer to the spinal cord. This is why the analgesic effect of a spinal pain catheter sets in faster than that of an epidural catheter.

What drugs are administered through the pain catheter?

For pain therapy, the doctor administers locally effective anesthetics, so-called local anesthetics, to the patient via the catheter. Their effect is based on the blockade of ion channels, which hinders the conduction of excitation in the nerves: you can no longer transmit the pain, or only pass it on to a lesser extent.

When do you need a pain catheter?

Catheters close to the spinal cord serve as a supplement to general anesthesia in surgical interventions, for example in the following interventions:

surgical removal (resection) of the lungs, esophagus, stomach, liver and other organs in the chest or abdomen
Therapy of a bulging of the main artery (aortic aneurysm)
Surgery on the colon (including rectum) or small intestine
gynecological interventions, for example removal of the uterus
natural childbirth or caesarean section
trauma surgery and orthopedic interventions, for example knee replacement

Pain catheters distant from the spinal cord

Peripheral pain catheters, i.e. distant from the spinal cord, are often used after trauma surgery when the patient is in severe pain. The pain medication allows the patient, for example, to start physiotherapeutic exercises more quickly after an operation, which promote the healing process.

After amputations, i.e. the severing of limbs, early administration of painkillers via a catheter can also counteract the development of so-called phantom pain.

What do you do when inserting a pain catheter?

Where the pain catheter is placed depends on which region of the body is to be anesthetized. For example, during childbirth, after disinfecting the skin, the doctor inserts the needle between the third and fourth lumbar vertebrae.

The application of a pain catheter close to the spinal cord differs from that of a peripheral catheter for blocking individual nerves.

Pain catheters: procedures near the spinal cord

To perform epidural anesthesia, the patient should take a seated position and hunch back, so to speak, like a hunchback. A small amount of local anesthetic will also be injected into the puncture site. Now the doctor inserts the hollow epidural needle. As soon as a drop of spinal fluid drips from the hollow needle, the epidural space is reached. The doctor then pushes the thin pain catheter over the hollow needle so that it lies a few centimeters deep in the epidural space. This can now be used to inject anesthetic.

So that the catheter does not slip out and the puncture site is protected from germs, the doctor sticks a transparent plaster over it and attaches the catheter tube to the patient's back with plaster strips. If necessary, the catheter is connected to a pump, which the patient can use to administer painkillers himself if necessary.

Racz catheter

A newer method of pain catheterization is the so-called Racz catheter. This is so flexible that it can be pushed forward through a small puncture channel in the skin at the lower end of the lumbar spine. In the spinal canal, the doctor pushes the catheter up to the desired location in the spinal canal under image control and can administer the anesthetic there.

Peripheral pain catheters: shoulder and arm pain

Pain in the shoulder or arm area is treated with a blockade of the so-called brachial plexus: This is a network of nerves from which numerous nerves originate for the sensation of the arm. First, the doctor carefully disinfects the puncture site near the shoulder to prevent infections. Then he injects the patient with a drug to temporarily numb the skin. Using ultrasound, he can visualize the muscles and vessels in the shoulder area so that they are not injured when puncturing. Similar to a pain catheter close to the spinal cord, he now inserts the catheter tube through the inserted hollow needle and can now use it to administer anesthetics if necessary.

What are the risks of a pain catheter?

Catheterization for pain management is a routine procedure and is considered a safe procedure. However, the doctor must explain some of the risks to the patient: When inserting the pain catheter, bleeding or nerve injuries can occur. If the catheter is placed in the area of the chest, the lungs can accidentally be pierced - this leads to what is known as pneumothorax (air entry between the lungs and chest wall).

Accidental injection of painkillers into a vein is also feared: if the active ingredients are distributed through the bloodstream, they can trigger seizures and cardiac arrhythmias. However, if the painkillers are used properly by an experienced doctor, this is a very rare complication.

Long-term pain catheter

The catheter tube creates an artificial connection between the inside of the body and the outside world. This connection allows bacteria to rise and cause infections. The longer the pain catheter is in the body, the higher the risk of such a catheter infection.

It can also happen that the catheter slips or tears off, so that adequate pain therapy is no longer possible. If necessary, the pain catheter must then be re-applied.

What do I have to consider with a pain catheter?

After inserting the pain catheter, you as the patient should take care to protect the puncture site from dirt: When washing, make sure that neither soap nor water gets into the wound - it is best to use a shower plaster. In the event of pain, reddening or other unusual symptoms in the area of the puncture site, you should immediately consult a doctor so that any infection can be treated early.

A pain catheter distant from the spinal cord is usually removed after three to four days. In order to recognize a possible infection in good time, a nurse or the doctor will check the puncture site of the pain catheter daily and ask you about pain. If there is an infection, the doctor will remove the pain catheter immediately and treat you with antibiotics.

Tags: Diseases laboratory values first aid