Continuous peripheral nerve block in replantation and revascularization

Continuous infusion of a local anesthetic by means of a percutaneous forearm catheter and an infusion pump was studied for its utility in achieving sympathetic blockade following replantation and revascularization of the digits. The efficacy of the technique was demonstrated by cold stress testing. When the technique was used in 55 patients who underwent digital replantation or revascularization, 53 of 57 replanted digits (93 percent) and 25 of 26 revascularized digits (96 percent) survived. The analgesia obtained from the nerve block benefited patient comfort during hospitalization, and normal sensibility in the uninjured digits returned promptly after discontinuing the anesthetic in all but one patient. The reported study indicates that continuous peripheral nerve block by means of an indwelling forearm catheter is a safe and effective adjunct in preventing neurogenically-mediated vasospasm.