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Background and Aims In replantation surgery maintenance of limb perfusion and adequate analgesia are critical. Since regional anesthesia can offer pain control and vasodilation it plays an important part in this patient managing.1 These are long-lasting surgeries, there is sometimes a fear of using a single shot as anesthetic technique. The median duration of ropicacaíne induced anesthesic block varies between 4-8h.2 We report 4 cases of finger reimplantation surgeries performed under brachial plexus (BP) block without using any adjuvant.
Methods We describe 4 cases in which an alternative approach to axillary BP block was performed, under ultrasound-guidance, as anesthetic technique. After visualization of the median, the ulnar and the radial nerves, 10 mL of ropivacaine 0.5% was distributed around them. Then, a distal scan was performed and another 10 ml were administered when the 3 nerves were no longer surrounded by local anesthetic. A propofol perfusion was used to light sedation.
Results Surgeries lasted on average 8.6 hours and proceeded uneventful.
Conclusions Balance between anesthesia, analgesia and peripheral vasodilatation is not always easy since systemic agents used in general anesthesia and systemic analgesics may decrease median blood pressure and impair limb perfusion. The same happens when adrenaline is used as adjuvant to prolong peripheral blocks. With this case series we were able to show that with a single shot BP block it is possible to safely perform a 9 hour surgery without use of any adjuvant, taking advantage of all the benefits of the sympathetic block and analgesia associated with this technique.
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