Chlorhexidine Versus Betadine in Preventing Colonization of Femoral Nerve Catheters After Total Joint Arthroplasty (TJA)
Status:
Withdrawn
Trial end date:
2015-06-01
Target enrollment:
Participant gender:
Summary
Continuous femoral nerve block (CFNB) techniques continue to be increasingly used in the
management of postoperative pain after total knee arthroplasty. Although the risk of full
blown infection with CFNB has been poorly defined, the rate of catheter colonization after
antisepsis with povidone-iodine has been demonstrated to be high (Cuivillion et al. showed
the rate of colonization to be 57% after 48 hours). Recently, several anecdotal case reports
have demonstrated severe infectious complications including psoas abscess and necrotizing
fasciitis associated with continuous nerve block techniques. As the use of CFNB techniques
increase in popularity, infectious complications will undoubtedly become more common.
The American Society of Regional Anesthesia and Pain Medicine recommends the routine use of
antiseptic solutions with an alcohol base for skin disinfection before peripheral regional
techniques due to their penetration of the stratum corneum and their rapid and prolonged
effect. Chlorhexidine(chloraprep) has been proven to be better than povidone iodine solution
for skin preparation before epidural catheter and intravascular device insertion (Kinirons et
al., Ostrander et al., Mimoz et al.,). The goal of this prospective trial therefore is to
determine if an alcoholic solution of 0.5% chlorhexidine is more effective than an aqueous
solution of 10% povidone-iodine in reducing catheter colonization and reducing skin flora
associated with short term ( 48 hours) postoperative continuous femoral nerve catheter
placement. The investigators will also compare the ability of chloraprep and betadine
disinfection at the time of catheter placement to prevent bacterial contamination of the
continuous femoral catheter.