Background and Aims A 39- year -old male with an 8-year history of chronic back, knee, neck, and ankle pain treated with buprenorphine-naloxone was scheduled for a middle finger distal interphalangeal joint arthrodesis and internal fusion. The patient was very concerned for analgesia following the surgery and wanted to avoid additional opioids.
Methods The patient had an axillary brachial plexus block preformed for the primary anesthesia for surgery.In the recovery room the distal median nerve was hydro dissected with ultrasound guidance using a 25- gauge needle with 10cc of 0.5% ropivacaine. (Figure 1) After a fluid collection was developed an 18-gauge needle was advanced adjacent to the median nerve and a catheter was advanced 5 cm. (Figure 2) The catheter was secured and an infusion of 0.2% ropivacaine at 4 cc per hour was infused for 5 days. (Figure 3)
Results The patient reported no surgical pain and required no opioids during the duration of the catheter. Postoperative radiographs at 2 weeks showed bony bridging indicative of early bone fusion. The middle finger sensation returned 24 hours following the discontinuation of the infusion and the patient reported minimal pain.
Conclusions A distal nerve catheter can provide excellent analgesia while maintaining motor function of the arm.Additional benefits may be in increasing the blood flow and decreasing the fusion time which needs further investigation.
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