Observation On The Effect Of Ultrasound-guided Continuous Axillary Brachial Plexus Block For Severed Finger Replantation

Objective To compare different analgesic effects of high-resolution ultrasound-guided and nerve stimulator-guided continuous axillary brachial plexus blocks for patient controlled nerve analgesia(PCNA) in finger replantation.Methods 120 cases(155 fingers in total) undergoing finger replantation(ASA I or II)were selected from June 2013 to August 2014. After excluding those with cardiovascular diseases and hypertension, these patients were randomly divided into group A and group B, 60 cases for each group. 20 ml injection of 0.375% ropivacaine was given to Group A undergoing ultrasound-guided axillary brachial plexus block and catheter was inserted,while 20 ml injection of 0.375% ropivacaine was given to Group B undergoing stimulator-guided continuous axillary brachial plexus blocks. Both groups were connected with a patient-controlled analgesia pump at the site of the brachial plexus analgesic catheter. The pumps contained 0.18% ropivacaine+100ug sufentanil+0.9% normal saline(200ml in total), at a rate of 2ml/h. The pumps were maintained at 1.0ml/30 min. The catheters and pumps were removed three days after operation. Mean artery pressures(MAP) and heart rates(HR) before anesthesia, 5min after medicine injection, at the beginning of operation, 30 min after the beginning of operation, and after operation were observed and recorded. Anesthetic operation times and block onset times were recorded,and the anesthesia effects were evaluated. Visual analogue pain scores(VAS) and Ramsay sedation scores at 8h, 12 h, 24 h and 48 h after operation as well as PCA demand times within 48 h after operation were recorded. Furthermore, incidences of complications were observed and recorded.Results Group A and group B showed no significant difference in MAPs and HRs before anesthesia, 5min after medicine injection, 30 min after the beginning of operation,and after operation(P>0.05), but MAP and HR of group A at the beginning of operation was much lower than those of group B, showing statistically significant differences(P<0.05); The anesthetic operation time and block onset time of group A was much lower than those of group B, showing statistically significant differences(P<0.05); The anesthetic effect was excellent in 100% of group A, much higher than 86.7% of group B,showing a statistically significant difference(P<0.05); VAS at 8h, 12 h, 24 h and 48 h after operation were much lower than group B, showing statistically significant differences(P<0.05); Group A and group B showed no statistically significant differences in Ramsay sedation scores at 8h, 12 h, 24 h and 48 h after operation(P>0.05); Group A used analgesic drugs during operation for eight times(13.3%) and group B used analgesic drugs for eighteen times(30.0%), showing a statistically significant difference(P<0.05); Group A used analgesic drugs after operation for eight times(13.3%) and group B used analgesic drugs for sixteen times(26.6%), showing a statistically significant difference(P<0.05);PCA demand times within 48 h after operation of group A were(4.12±0.91), much lower than(7.53±1.27) of group B, showing a statistically significant difference(P<0.05).A case of nerve injury occurred in the A group, and two cases occurred in the B group. A case of mild local anesthetics poisoning occurred in the B group. A,B group did not find complications of hematoma and postoperative catheter infection.Conclusion For severed upper extremity finger replantation, high-resolution ultrasound-guided continuous axillary brachial plexus block for patient controlled nerve analgesia has good intraoperative and postoperative analgesic effects, enhances the success rates of puncturing and catheter indwelling and improves the excellent rate of anesthetic effect.