Postoperative continuous interscalene brachial plexus blockade for hand surgery.
Interscalene brachial plexus blockade is a well-established means of providing analgesia and anesthesia for upper extremity surgery. Extension into the postoperative period with continuous infusions of 0.25% bupivacaine provides several added advantages. Our survey over two years covered 126 patients undergoing surgery by the Department of Hand Surgery of our hospital. Postoperative verbal analogue pain scores obtained for three days showed scores of 4 or less (range 0 to 10) being reported by more than 70% of all patients with 6.3% and 11.9% requiring additional narcotics and non-steroidal anti-inflammatory drugs, respectively. Compliance with early occupational therapy was good with only 7 patients having difficulty with active mobilisation as a result of excessive motor blockade. The insertion complication rate was 11.1%; all these cases were attributed to the bolus dose given and resolved over the next few hours. Eighteen (14.3%) of the patients developed complications while on continuous infusion, the most frequent being catheter dislodgement and pain at the insertion site. In all we found this method of providing postoperative analgesia to be effective, inexpensive and easy to implement in our large hospital setting.
Koh
D L
DL
Department of Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore.
Lim
B H
BH
D000328:Adult; D001917:Brachial Plexus / Q000187:drug effects*; D002045:Bupivacaine; D005260:Female; D006225:Hand / Q000601:surgery*; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008866:Microsurgery; D009407:Nerve Block / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*
D002045:Bupivacaine