Implantable port tunneling technique
Abstract:
Background: The study examines whether omitting local anesthesia at the tunneling site during subcutaneous port catheter implantation is associated with differences in patient comfort and procedural outcomes through pain assessment during tunneling.
Materials and methods: The study included 243 patients who underwent subcutaneous port catheter placement at one interventional radiology unit. Patients received local anesthesia through three injection sites – vascular access, tunneling, and port pocket (n=121) – or through two sites – vascular access and port pocket only (n=122). The primary outcome was tunnel-site pain assessed by Visual Analog Scale. Secondary outcomes included patient satisfaction, complication rates, procedure duration, additional anesthetic requirements, and total anesthetic consumption. Between-group differences were evaluated using appropriate statistical tests with p<0.05 as the significance threshold.
Results: No statistically significant difference was observed in mean pain levels during tunneling between the three-region and two-region groups (4.1±2.3 vs 3.8±2.1, mean difference 0.3, 95% CI: -0.35 to 0.95, p=0.361). No statistically significant difference in patient satisfaction was observed between groups [median 4 (IQR: 3-5) vs median 4 (IQR: 4-5), p=0.135]. Procedure duration showed no statistically significant difference (22.3±4.5 vs 21.7±4.2 minutes, p=0.517). Additional analgesia was required in 20.7% versus 15.6% of patients (p=0.302). Both groups demonstrated similarly low overall complication rates (7.4% vs 6.6%, p=0.791), with no significant differences in bleeding/hematoma (2.5% vs 1.6%, p=0.682), vasovagal reactions (1.7% vs 0.8%, p=0.621), or procedure interruptions (0.8% vs 0.8%, p=0.999).
Conclusions: No statistically significant differences were observed in pain scores, patient satisfaction, procedure duration, or complication rates between the two approaches. These findings suggest that omitting tunnel-site anesthesia may be feasible when a blunt-tip stylet is employed.
Reference:
Bolgen C, Karluka I. Subcutaneous Port Implantation without Tunneling Site Anesthesia: A Feasible and Efficient Approach? Ann Vasc Surg. 2026 Mar 25:S0890-5096(26)00185-8. doi: 10.1016/j.avsg.2026.03.022. Epub ahead of print. PMID: 41895596.