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Abstract
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Background and Aims Tenolysis requires complete division of tendons followed by early mobilization. Rapid development of adhesions following surgery necessitate adequate analgesia to facilitate early active exercise programmes. Regional anaesthesia provides superior pain relief and reduces opioid requirements. A continuous ambulatory catheter allows for the patient to recuperate outpatient and shortens hospital stay while maintaining good post operative analgesia. Targeting distal terminal branch nerves also reduces the incidence of motor block thus facilitating physiotherapy and recovery.
POD0 post insertion of forearm catheters
POD6 during hand review
Methods A 50-year-old woman presented with post operative stiffness of left ring finger following open reduction and internal fixation of proximal interphalangeal joint fracture. In view of her limited active range of motion, she underwent removal of implants and tenolysis of flexor and extensor tendons under regional anaesthesia with an infraclavicular brachial plexus block. Following surgery, ultrasound guided insertion of median and ulnar nerve catheters at the level of the forearm was performed and continuous infusions of 0.2% Ropivacaine via two balloon infuser pumps was started. The patient was guided on care of outpatient catheters and allowed to self-titrate the infusion rates to maintain analgesia while avoiding excessive motor blockade.
Results On post operative day six, she was able to move fingers with minimal pain and oral analgesia and catheters were removed by herself the next day.
Conclusions This case highlights the use of ambulatory catheters for post operative analgesia in the outpatient setting to promote early physiotherapy.