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Related Experiment Videos

Continuous peripheral nerve block in replantation and revascularization

J S Taras1, M J Behrman

  • 1Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Journal of Reconstructive Microsurgery
|April 2, 1998
PubMed
Summary

Continuous local anesthetic infusion via forearm catheter effectively prevents vasospasm after digital replantation and revascularization. This technique improves digit survival and patient comfort, demonstrating its value in reconstructive surgery.

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Area of Science:

  • Reconstructive Surgery
  • Pain Management
  • Vascular Surgery

Background:

  • Digital replantation and revascularization are critical procedures.
  • Postoperative vasospasm remains a significant complication, potentially leading to graft failure.
  • Effective sympathetic blockade is essential for successful outcomes.

Purpose of the Study:

  • To evaluate the efficacy of continuous peripheral nerve block using a forearm catheter for sympathetic blockade.
  • To assess the impact of this technique on digital replant and revascularization survival rates.
  • To determine the benefits of continuous local anesthetic infusion on patient comfort and sensory recovery.

Main Methods:

  • Continuous infusion of local anesthetic via a percutaneous forearm catheter and infusion pump.

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  • Utilized cold stress testing to demonstrate the effectiveness of sympathetic blockade.
  • Studied in 55 patients undergoing digital replantation or revascularization.

    • Main Results:

    • High survival rates: 93% for replanted digits (53/57) and 96% for revascularized digits (25/26).
    • Significant patient comfort improvement due to analgesia during hospitalization.
    • Prompt return of normal sensibility in uninjured digits after anesthetic discontinuation in most patients.

    Conclusions:

    • Continuous peripheral nerve block with an indwelling forearm catheter is a safe and effective method.
    • This technique serves as a valuable adjunct in preventing neurogenically-mediated vasospasm.
    • The approach enhances graft survival and improves the patient experience in digital reconstructive surgery.