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32 Successful selective sensory nerve blocks for awake hand surgery using nerve stimulator
  1. A Oiwa
  1. Toho University School of Medicine, Oomori-Nishi, Ota-ku, Tokyo, Japan


Background and Aims The selective sensory nerve blocks in awake tendon reconstruction have been started since 2020 in our institute. We managed these surgeries under general anesthesia combined with blocking only sensory nerves under echo guidance.

Methods In this presentation, we would like to present 11cases and extract our problems. The surgeries were finger tendon repairs and finger/hand joint functional reconstructions. The tourniquet was used during surgery in all cases. General anesthesia was performed by the ‘asleep-awake’ technique, and the patient was awakened when the tourniquet was released after the tendon repairment.

Results The sites of regional anesthesia were the lateral forearm cutaneous nerve, the medial upperarm/forearm cutaneous nerve, the posterior cutaneous nerve, the distal radial nerve, the forearm interosseous nerve, and the distal ulnar nerve.

2.5–4 ml of 0.1 to 0.125% levobupivacaine was used for cutaneous nerves and 1–3 ml of 0.5% levobupivacaine was used for other nerves. In all 8 cases, it was possible to move their digits during surgery. The most important is, even though we tried to reduce the injection amount and tried more regionally, but in the first 2 cases, the maintenance of finger muscles strength was slightly insufficient. After using the nerve stimulator, this problem was resolved.

Conclusions There was one patient who complained of pain, but it was possible to deal with adding local anesthesia. No vomiting, toxicity or respiratory problems were observed, and no cases abandoned awakening. Hand surgery with selective sensory nerve blocks was a good method with high treatment accuracy.

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