Instrument and method for delivery of anaesthetic drugs

• US 20040049231A1
• Filed: 05/20/2003
• Published: 03/11/2004
• Est. Priority Date: 03/13/2000
• Status: Active Grant

• Current Assignee: Teleflex Life Sciences Limited (Teleflex Incorporated)
• Original Assignee: Arrow International Investment Corporation (Teleflex Incorporated)
• Inventors: Hafer, Fred
• Granted Patent: US 7,386,341 B2
• Time in Patent Office: Days
• US Class Current: 607/3
• CPC Class Codes: A61B 17/3401 Puncturing needles for the peridural or subarachnoid space or the plexus, e.g. for anaesthesia local anaesthesia A61M19/00
• CPC Class Codes: A61B 18/1492 having a flexible, catheter-like structure, e.g. for heart ablation A61B18/1477 takes precedence
• CPC Class Codes: A61N 1/0551 Spinal or peripheral nerve electrodes
• CPC Class Codes: A61P 23/02 Local anaesthetics

Abstract

A needle and catheter system, including components, is provided such that the position of an stimulating needle may be identified after insertion into the body of a patient by electrically stimulating and thus locating a specific nerve. Positioning of the stimulating needle while simultaneously controlling and monitoring the electrical impulses applied therethrough is made possible by a control device and monitor integral with the stimulating needle. When a specific nerve is located, the catheter is inserted through the needle to a point slightly beyond the distal tip of the needle. The catheter tip may then be manipulated and the optimum position for the catheter tip determined by applying an electrical impulse through the helical wire and/or the ribbon support wire to the proximal tip catheter, this electrical stimulation being utilized in determining the specific location of the catheter tip within the nerve. Once properly located, or at any time relative movement between the catheter and needle is not desirable, the catheter can be locked into position with a catheter lock which may be part of the stimulating needle hub. A catheter adapter is utilized to allow easy access to the catheter and introduction of fluid into the nerve of the patient through the catheter tip.

Claims

1. A medical-surgical instrument comprising:

a. a needle for providing access to and electrically stimulating a nerve of a patient;

b. a catheter for providing access to and electrically stimulating the nerve of the patient, said catheter (capable of being inserted into the patient through said needle; and

c. whereby the electrically stimulating function of the needle and the electrically stimulating function of the catheter may be utilized to achieve placement of a tip of the catheter at a desired location.

2. The medical-surgical instrument of claim 1, further comprising a connector for providing a connection for electrical stimulation from a source of electricity to said needle.

3. The medical-surgical instrument of claim 1, wherein the tip of the catheter is electrically conducting.

4. The medical-surgical instrument of claim 1, wherein the catheter further comprises a bore for conveying a liquid.

5. The medical-surgical instrument of claim 4, wherein the catheter further includes a liquid exit proximate the distal tip for allowing delivery of a liquid to the patient proximate the distal tip of the catheter.

6. The medical-surgical instrument of claim 4, wherein the catheter further includes a liquid exit as an integral part of a distal tip of the catheter for allowing delivery of a liquid to the patient through the distal tip of the catheter.

7. The medical-surgical instrument of claim 1, wherein the catheter further comprises a conducting wire extending from a proximal end of the catheter to an electrically conducting distal tip of the catheter.

8. The medical-surgical instrument of claim 7, wherein the conducting wire is approximately parallel with the catheter in an axial direction for a majority of the length of the conducting wire.

9. The medical-surgical instrument of claim 7, wherein the conducting wire is helically shaped.

10. The medical-surgical instrument of claim 1, further comprising a catheter retention clip having a handle and a retention area such that the catheter may be coiled when packaged.

11. The medical-surgical instrument of claim 1, wherein the catheter comprises an electrically insulating thermoplastic sheath and a supporting structure disposed in supporting contact with the thermoplastic sheath along at least substantially the entire length of the thermoplastic sheath.

12. The medical-surgical instrument of claim 11, wherein the supporting structure is a helical wire.

13. The medical-surgical instrument of claim 12 wherein the helical wire is electrically conducting.

14. A medical-surgical instrument comprising:

a. a needle having a central bore and a hub disposed at a proximal end of the needle;

b. the needle being capable of conveying electricity to a distal end of the needle;

c. a catheter having a proximal end, a distal end, an electrically conducting distal tip and an electrically conducting wire extending from the proximal end to the distal end and conductively connected to the distal tip, the catheter is thus able to convey electricity from the proximal end of the catheter to the distal tip of the catheter; and

d. the catheter being adapted to be inserted through the needle central bore such that the distal tip of the catheter extends beyond the distal end of the needle.

15. The medical-surgical instrument of claim 14, further comprising an insulated wire, a first end of the insulated wire is conductively connected to the needle and a second end of the insulated wire is adapted to be conductively connected to a source of electricity.

16. The medical-surgical instrument of claim 14, wherein the catheter additionally comprises a central bore capable of conveying a liquid therethrough.

17. The medical-surgical instrument of claim 16, wherein the catheter further includes a liquid exit proximate the distal tip for allowing delivery of a liquid to the patient proximate the distal tip of the catheter.

18. The medical-surgical instrument of claim 16, wherein the catheter further includes a liquid exit as an integral part of a distal tip of the catheter for allowing delivery of a liquid to the patient through the distal tip of the catheter.

19. The medical-surgical instrument of claim 14, wherein the needle additionally comprises an outer surface between the proximal end and distal end of the needle, a portion of the outer surface of the needle being covered by an electrically insulating covering.

20. The medical-surgical instrument of claim 14, wherein the electrically insulating covering further comprises markings, whereby the markings convey information regarding a depth to which the needle is inserted into a patient.

21. The medical-surgical instrument of claim 14, wherein the conducting wire is substantially parallel to the axis of the catheter and has a proximal end that is connected to the proximal end of the catheter.

22. The medical-surgical instrument of claim 14, wherein the conducting wire is helical.

23. The medical-surgical instrument of claim 14 wherein the catheter comprises an electrically insulating thermoplastic sheath and a supporting structure disposed in supporting contact with the thermoplastic sheath along at least substantially the entire length of the thermoplastic sheath.

24. The medical-surgical instrument of claim 23 wherein the supporting structure is a helical wire.

25. The medical surgical instrument of claim 24 wherein the helical wire extends distally of the thermoplastic sheath such that the distal end of the catheter comprises the helical wire not covered by the thermoplastic sheath.

26. The medical-surgical instrument of claim 24 wherein the helical wire extends proximally of the thermoplastic sheath such that the proximal end of the catheter comprises the helical wire not covered by the thermoplastic sheath.

27. The medical-surgical instrument of claim 24 wherein the helical wire is electrically conducting.

28. The medical-surgical instrument of claim 27 wherein the conducting wire is conductively connected to the distal tip of the catheter.

29. The medical-surgical instrument of claim 27 wherein the conducting wire is conductively connected to the helical wire near the proximal end of the catheter.

30. The medical-surgical instrument of claim 14, further comprising a catheter retention clip having a handle and a retention portion.

31. A medical-surgical instrument comprising:

a. a needle having a central bore and a hub disposed at a proximal end of the needle;

b. an adapter connector, being conductively connected to a source of electricity;

c. a catheter having a proximal end, a distal end, an electrically conducting distal tip and a conducting wire extending from the proximal end of the catheter to the distal end of the catheter and conductively connected to the distal tip, the conducting wire adapted to conduct an electrical impulse from the proximal end of the catheter to the distal tip;

d. the adapter connector being sized to receive and frictionally retain the proximal end of the catheter and conductively connect the source of electricity to the conducting wire of the catheter, such that electrical impulses from the source of electricity are conducted via the adapter connector and the conducting wire of the catheter, to the distal tip of the catheter; and

e. the catheter being adapted to be inserted through the needle central bore.

32. The medical-surgical instrument of claim 31, further comprising an insulated wire, a first end of the insulated wire being conductively connected to the adapter connector and a second end of the insulated wire being conductively connected to the source of electricity.

33. The medical-surgical instrument of claim 31, further comprising a stimulator connector conductively connected to the second end of the insulated wire and adapted such that the insulated wire may be connected to the source of electricity.

34. The medical-surgical instrument of claim 31, wherein the catheter additionally comprises a central bore capable of conveying a liquid along substantially the entire length of the catheter.

35. The medical-surgical instrument of claim 34, wherein the catheter further includes a liquid exit proximate the distal tip for allowing delivery of a liquid to the patient proximate the distal tip of the catheter.

36. The medical-surgical instrument of claim 34, wherein the catheter further includes a liquid exit as an integral part of a distal tip of the catheter for allowing delivery of a liquid to the patient through the distal tip of the catheter.

37. The medical-surgical instrument of claim 31, wherein the needle additionally comprises an outer surface between the proximal end and distal end of the needle, a portion of the outer surface of the needle being covered by an electrically insulating covering.

38. The medical-surgical instrument of claim 31, wherein the conducting wire is substantially parallel to the axis of the catheter and has a proximal end that is connected to the proximal end of the catheter.

39. The medical-surgical instrument of claim 31, wherein the conducting wire is helical.

40. The medical-surgical instrument of claim 31, wherein the catheter comprises an electrically insulating thermoplastic sheath and a supporting structure disposed in supporting contact with the thermoplastic sheath along at least substantially the entire length of the thermoplastic sheath.

41. The medical-surgical instrument of claim 40 wherein the supporting structure is a helical wire.

42. The medical-surgical instrument of claim 41 wherein the helical wire is electrically conducting.

43. The medical surgical instrument of claim 41 wherein the helical wire extends distally of the thermoplastic sheath such that the distal end of the catheter comprises the helical wire not covered by the thermoplastic sheath.

44. The medical-surgical instrument of claim 41 wherein the helical wire extends proximally of the thermoplastic sheath such that the proximal end of the catheter comprises the helical wire not covered by the thermoplastic sheath.

45. The medical-surgical instrument of claim 41 wherein the conducting wire is conductively connected to the helical wire near the proximal end of the catheter and the adapter connector conductively connects the insulated wire to the conducting wire of the catheter through the helical wire.

46. A medical-surgical instrument comprising:

a. a catheter having a proximal end, a distal end, an electrically conducting distal tip attached proximate the distal end and an electrically conducting wire extending from the proximal end of the catheter to the distal end of the catheter and conductively connected to the distal tip of the catheter;

b. a catheter adapter configured and dimensioned such that the catheter may be inserted into a central bore of the catheter adapter and be rigidly retained in the central bore; and

c. the catheter adapter connected to a source of electricity.

47. The medical-surgical instrument of claim 46, further comprising an insulated wire, a first end of the insulated wire is conductively connected to the proximal end of the catheter and a second end of the insulated wire is adapted such that it can be connected to the source of electricity.

48. The medical-surgical instrument of claim 46, the catheter further comprising a bore for conveying a liquid, the central bore of the catheter adapter being in liquid communication with the bore of the catheter.

49. The medical-surgical instrument of claim 48, the catheter further comprising a liquid exit proximate the distal tip for allowing delivery of a liquid to a patient proximate the distal tip of the catheter.

50. The medical-surgical instrument of claim 48, the catheter further comprising a liquid exit as an integral part of a distal tip of the catheter for allowing delivery of a liquid to a patient through the distal tip of the catheter.

51. The medical-surgical instrument of claim 48, the catheter adapter further comprising a connector adapted to allow attachment of an apparatus for the controlled delivery of fluid to the central bore of the adapter and thus the bore of the catheter.

52. The medical-surgical instrument of claim 46, wherein the conducting wire is adapted to conduct electricity from the proximal end of the catheter to the distal tip of the catheter.

53. The medical-surgical instrument of claim 46, wherein the catheter adapter comprises a catheter grasping portion having an outer surface and a central bore, a connector having a central bore and extending proximally from the catheter grasping portion, the connector adapted to allow attachment of an apparatus for controlled delivery of fluid, a cylinder having a central bore and an inner surface defining the central bore is connected to the catheter grasping portion and extends distally from the catheter grasping portion, each of the central bores of the catheter grasping portion, the connector and the operating cylinder are coaxial, extend the entire length thereof and are in communication;

a. at least a section of the catheter grasping portion is disposed in the central bore of the operating cylinder, the outer surface of the catheter grasping portion and the inner surface of the operating cylinder being adapted such that movement of the two portions relative to one another causes the operating cylinder to compress the catheter grasping portion such that when a catheter is disposed in the central bore of the grasping portion and the grasping portion is compressed the catheter is firmly frictionally held by the grasping portion and when the grasping portion is not compressed, the catheter may freely and easily be removed from the catheter adapter.

54. The medical-surgical instrument of claim 53, wherein the first end of the insulated wire extends into the central bore of the catheter grasping portion such that the conducting wire of the catheter will come into conductive contact with the first end of the insulated wire when the catheter is inserted into the catheter grasping portion.

55. A medical-surgical instrument comprising:

a. a catheter having a proximal end, a distal end, an electrically conducting distal tip attached proximate the distal end and an electrically conducting wire extending from the proximal end of the catheter to the distal end of the catheter and conductively connected to the distal tip of the catheter;

b. catheter adapter means for grasping the proximal end of said catheter means; and

c. an insulated wire, a first end of the insulated wire is conductively connected to the catheter adapter and a second end of the insulated wire is adapted such that it can be connected to a source of electricity.

56. The medical-surgical instrument of claim 55, the catheter further comprising a bore for conveying a liquid, the catheter adapter means comprising a central bore being in liquid communication with the bore of the catheter.

57. The medical-surgical instrument of claim 56, the catheter further comprising a liquid exit proximate the distal tip for allowing delivery of a liquid to a patient proximate the distal tip of the catheter.

58. The medical-surgical instrument of claim 56, the catheter further comprising a liquid exit as an integral part of a distal tip of the catheter for allowing delivery of a liquid to a patient through the distal tip of the catheter.

59. The medical-surgical instrument of claim 56, the catheter adapter means further comprising a connector adapted to allow attachment of an apparatus for the controlled delivery of fluid to the central bore of the adapter and thus the bore of the catheter.

60. The medical-surgical instrument of claim 55, wherein the conducting wire is adapted to conduct electricity from the proximal end of the catheter to the distal tip of the catheter.

61. A medical-surgical instrument comprising:

a. a needle for providing access to a nerve of a patient;

b. a catheter for providing access to and electrically stimulating the nerve of the patient, the catheter capable of being inserted into the patient through the needle; and

c. catheter lock means attached to the needle for selectively holding said catheter stationary with respect to said needle or allowing said catheter to slide through said catheter lock and said needle.

62. The medical-surgical instrument of claim 61, wherein the needle further comprises a wire with a first end attached to a proximal end of the needle and a second end adapted to be connected to a source of electricity, for conveying electricity provided by the source of electricity to the needle.

63. The medical-surgical instrument of claim 61, wherein the catheter is inserted through the catheter lock means and needle such that a distal tip of the catheter extends beyond a distal end of the needle.

64. The medical-surgical instrument of claim 61, wherein the catheter additionally comprises a central bore capable of bringing a liquid from a proximal end of the catheter to the nerve of the patient.

65. The medical-surgical instrument of claim 61, wherein the needle additionally comprises an electrically insulating covering on an outer surface of the needle means.

66. The medical-surgical instrument of claim 61 wherein a proximal end of the catheter is inserted into and frictionally held by a catheter adapter, whereby a fluid delivery apparatus to supply a fluid to said catheter is attached to the catheter through the intermediary of the catheter adapter.

67. The medical-surgical instrument of claim 61 wherein a proximal end of the catheter is inserted into and frictionally held by a catheter adapter, whereby a source of electricity to supply electricity to said catheter is conductively attached to the catheter through the intermediary of the catheter adapter.

68. The medical-surgical instrument of claim 61 wherein the catheter means further comprises support means for supporting the catheter means.

69. The medical-surgical instrument of claim 68 wherein the support means comprises a helical wire underlying the catheter means.

70. The medical-surgical instrument of claim 69 wherein the support means is electrically conducting.

71. A medical-surgical instrument comprising:

a. a needle having a central bore and a hub disposed about a proximal end of the needle;

b. a catheter having a proximal end, a distal end, an electrically conducting distal tip, the catheter adapted to conduct an electricity from the proximal end of the catheter to the distal tip of the catheter;

c. a catheter lock comprising a bore and an actuating portion; and

d. the catheter being inserted through the bore of the catheter lock and the needle central bore such that actuation of the actuating portion of the catheter lock causes the catheter lock to frictionally hold the catheter in place with respect to the catheter lock.

72. The medical-surgical instrument of claim 71, wherein the catheter further comprises a bore for conveying a liquid.

73. The medical-surgical instrument of claim 72, wherein the catheter further includes a liquid exit proximate the distal tip for allowing delivery of a liquid to a patient proximate the distal tip of the catheter.

74. The medical-surgical instrument of claim 72, wherein the catheter further includes a liquid exit as an integral part of a distal tip of the catheter for allowing delivery of a liquid to a patient through the distal tip of the catheter.

75. The medical-surgical instrument of claim 71, wherein the catheter further comprises a conducting wire extending from the proximal end of the catheter to the electrically conducting distal tip of the catheter.

76. The medical-surgical instrument of claim 71, wherein the conducting wire is approximately parallel with the catheter in an axial direction for a majority of the length of the conducting wire.

77. The medical-surgical instrument of claim 71, wherein the conducting wire is helically shaped.

78. The medical-surgical instrument of claim 71, wherein the catheter comprises an electrically insulating thermoplastic sheath and a supporting structure disposed in supporting contact with the thermoplastic sheath along at least substantially the entire length of the thermoplastic sheath.

79. The medical-surgical instrument of claim 78 wherein the supporting structure is a helical wire.

80. The medical-surgical instrument of claim 79 wherein the helical wire is electrically conducting.

81. The medical-surgical instrument of claim 71, the catheter lock further comprising:

a. a stationary body portion attached to the hub and extending proximally therefrom;

b. the actuating portion comprising a rotatable body portion rotatably engaged with the stationary body portion; and

c. means for firmly grasping a portion of the catheter disposed through the bore of the stationary body portion, said means being engaged and disengaged by the actuating portion.

82. The medical-surgical instrument of claim 81, wherein the catheter additionally comprises a central bore capable of conveying a liquid along substantially the entire length of the catheter.

83. The medical-surgical instrument of claim 81, wherein the needle additionally comprises an outer surface between the proximal end and a distal end of the needle, a portion of the outer surface of the needle being covered in an electrically insulating covering.

84. The medical-surgical instrument of claim 81, further comprising a conducting wire extending from the proximal end of the catheter to the distal end of the catheter and conductively connected to the distal tip.

85. The medical-surgical instrument of claim 84, wherein the conducting wire is substantially parallel to the axis of the catheter.

86. The medical-surgical instrument of claim 84, wherein the conducting wire is connected to the proximal end of the flexible catheter.

87. The medical-surgical instrument of claim 81 wherein the catheter comprises an electrically insulating thermoplastic sheath and a supporting structure disposed in supporting contact with the thermoplastic sheath along at least substantially the entire length of the thermoplastic sheath.

88. The medical-surgical instrument of claim 87 wherein the supporting structure is a helical wire.

89. The medical-surgical instrument of claim 88 wherein the helical wire is electrically conducting.

90. The medical surgical instrument of claim 88 wherein the helical wire extends distally of the thermoplastic sheath such that the distal end of the catheter comprises the helical wire not covered by the thermoplastic sheath.

91. The medical-surgical instrument of claim 88 wherein the conducting wire is conductively connected to the helical wire near the proximal end of the catheter.

92. The medical-surgical instrument of claim 88 wherein the helical wire extends proximally of the thermoplastic sheath such that the proximal end of the catheter comprises the helical wire not covered by the thermoplastic sheath.

93. The medical-surgical instrument of claim 88 wherein the proximal end of the catheter is received within catheter adapter means for allowing connection of a fluid delivery apparatus.

94. The medical-surgical instrument of claim 88 wherein the proximal end of the catheter is received within catheter adapter means for allowing connection of a source of electricity to the proximal end of the catheter, the catheter adapter includes an insulated wire and connector adapted to be connected to a source of electricity.

95. The medical-surgical instrument of claim 71, further comprising an insulated wire, a first end of the insulated wire is conductively connected to the proximal end of the needle and a second end of the insulated wire is adapted such that it can be connected to a source of electricity, such that the needle is capable of conveying electricity provided by the source of electricity from the proximal end to a distal end of the needle.

96. The medical-surgical instrument of claim 71, wherein the catheter is inserted through the catheter lock and needle central bore such that the distal tip of the catheter extends beyond a distal end of the needle.

97. A medical-surgical instrument comprising:

a. a needle having a central bore and a support hub disposed about a proximal end of the needle;

b. an electrical controller supported by the support hub, the electrical controller comprising an input adapted to be connected to a source of electricity, an output connected to the proximal end of the needle and a switch; and

c. the needle being capable of conveying an electrical impulse provided by the source of electricity through the electrical controller, from the proximal end to a distal end of the needle.

98. The medical-surgical of claim 97 further comprising an insulated wire, a first end of the insulated wire is conductively connected to the electrical controller input and a second end of the insulated wire is adapted such that it can be connected to the source of electricity.

99. The medical-surgical instrument of claim 97 wherein the switch is a wheel switch.

100. The medical-surgical instrument of claim 97 wherein the switch is a slide switch.

101. The medical-surgical instrument of claim 97 further comprising a measurement device and read-out, wherein the measurement device measures the magnitude of the electrical impulse provided to the distal end of the needle and provides this measurement to the read-out to be displayed.

102. The medical-surgical instrument of claim 101 wherein the readout is supported by the support hub.

103. The medical-surgical instrument of claim 97, wherein the needle additionally comprises an outer surface between the proximal end and distal end of the needle, a portion of the outer surface of the needle being covered in an electrically insulating covering.

104. The medical-surgical instrument of claim 97 further comprising extensions from the hub such that the hub may be easily and firmly grasped and controlled during insertion of the needle into the patient.

105. The medical-surgical instrument of claim 104 wherein the electrical impulse controller is located so as to allow actuation of the electrical impulse controller while maintaining a firm grasp on the extensions.

106. The medical-surgical instrument of claim 104 further comprising a measurement device and read-out, wherein the measurement device measures the magnitude of the electrical impulse provided to the distal end of the needle and provides this measurement to the read-out to be displayed, are located so as to allow viewing of the read-out while maintaining a firm grasp on the extensions.

107. A method of using a medical-surgical instrument comprising the steps of:

a. accessing and electrically stimulating a nerve of a patient using a needle;

b. accessing and electrically stimulating the nerve of the patient using a catheter capable of being inserted into the patient through said needle; and

c. placing a tip of the catheter at a desired location in the nerve of the patient.

108. The method according to claim 107, wherein the desired location is found by:

a. noting the changing reaction of various muscles of the patient to movement of the catheter tip.

109. The method according to claim 108, further comprising:

a. injecting an anaesthetic through the catheter to effectuate a nerve block.

110. The method according to claim 109, further comprising:

a. subcutaneously tunneling a proximal end of the catheter.

111. A method for delivery of an anaesthetic drug to a nerve of a patient, comprising the steps of:

a. providing a needle assembly comprising a needle capable of conveying an electrical impulse from a proximal end of the needle to a distal tip of the needle, the needle having a hub disposed over the proximal end of the needle and supporting thereon an electrical controller;

b. inserting the distal tip of the needle through a first portion of skin of the patient to a position proximate the nerve; and

c. applying an electrical impulse to the proximal end of the needle which impulse is conveyed to the distal tip of the needle to confirm the appropriate placement of the distal tip by creating a twitching in muscle groups associated with the nerve, wherein the magnitude of the electrical impulse may be varied by the electrical controller associated directly with the needle assembly.

112. The method according to claim 111, further including a measurement device and read-out supported the needle assembly:

a. measuring the magnitude of the electrical impulse being applied to the nerve; and

b. providing a representation of that magnitude to the read-out.

113. A method for delivery of an anaesthetic drug to a nerve having a fascia sheath, comprising the steps of:

a. providing a needle assembly comprising a needle capable of conveying an electrical impulse from a proximal end to a distal tip of the needle;

b. inserting the distal tip of the needle to a position proximate the nerve;

c. applying a first electrical impulse to the proximal end of the needle which first impulse is conveyed to the distal tip of the needle to confirm the appropriate placement of the distal tip by creating a twitching in muscle groups associated with the nerve;

d. piercing the fascia sheath of the nerve with the distal tip of the needle;

e. providing a wire located within a catheter, the wire capable of conveying a second electrical impulse from the proximal end of the catheter to the distal end of the catheter, a distal end of the wire terminates at an electrically conducting wire distal tip;

f. advancing the distal end of the catheter and the wire distal tip through the needle assembly until the wire distal tip extends proximally of the distal tip of the needle, into the space between the fascia sheath and plexus of the nerve;

g. applying an electrical impulse to the wire distal tip and manipulating the location of the wire distal tip proximate the nerve to achieve the desired placement of the wire distal tip; and

h. injecting an anaesthetic through-the catheter to effectuate a nerve block.

114. The method according to claim 113, further including the step of removing the needle assembly.

115. The method according to claim 114, wherein the removal of the needle assembly is accomplished while maintaining the placement of the wire distal tip.

116. A method for delivery of an anaesthetic drug to a nerve having a fascia sheath, comprising the steps of:

a. inserting a distal tip of a needle assembly to a position proximate the nerve;

b. providing a wire located within a catheter, the wire capable of conveying an electrical impulse from the proximal end of the catheter to the distal end of the catheter, a distal end of the wire terminates at an electrically conducting wire distal tip;

c. advancing the distal end of the catheter and the wire distal tip through the needle assembly until the wire distal tip extends proximally of the distal tip of the needle;

d. applying an electrical impulse to the wire distal tip and manipulating the location of the wire distal tip proximate the nerve to achieve the desired placement of the wire distal tip;

e. inserting a distal tip of a tunneling device having a tunneler stylet portion and a sheath portion disposed over the tunneler stylet portion, at a second portion of the skin of the patient proximate the first portion of the skin of the patient;

f. advancing the distal tip of the tunneling device to exit the skin of the patient from the inside forming a subcutaneous tunnel;

g. removing the tunneler stylet portion while maintaining the sheath portion in place;

h. feeding the proximal end of the catheter into the one end of the sheath; and

i. removing the sheath from the patient, thus leaving the catheter tunneled subcutaneously between the skin portion where the tunneling device exited and the second skin portion.

117. The method of claim 116 wherein the skin portion where the needle exited and the first portion of skin are identical.

118. The method of claim 116 wherein a portion of the catheter external to patient is covered with a dressing.

119. The method of claim 116 further including the steps of:

a. inserting the catheter into a catheter adapter comprising

i. a holding hub for frictionally gripping the catheter; and

ii. an access port fluidly connected to an inner lumen of the catheter, the access port being dimensioned to allow access to the inner lumen of the catheter; and

b. actuating the catheter adapter such that the catheter is frictionally gripped by the catheter adapter.

120. The method of claim 119 further including the step of attaching an anaesthetic supply device to the access port of the catheter adapter.