title: [Application of separating brachial plexus block combined with preoperative analgesia by patient controlled intravenous analgesia in tendon repair].
abstract: OBJECTIVE
  To investigate whether the separating brachial plexus block combined with preoperative analgesia by patient controlled analgesia (PCA) can be applied in tendon repair and postoperative active or passive functional exercise.
  
  
  METHODS
  Two hundred and ten cases with tendon injury were randomly divided into 3 groups and all of the patients were administered Bupivacaine (0.25%), Papaverine (0.0625 mg/ml), and Dexamethasone (0.25 mg/ml) in separating brachial plexus block through axillary approach. Group A was control group, and preoperative analgesia was not applied. Preoperative analgesia was applied in group B and C. Tramadol and Ondansetron were administered in group B, Midazolam was administered besides Tramadol and Ondansetron in group C. The injection volume in the PCIA pump was increased to 100 ml by mixing physiologic saline. The pump was started after separating brachial plexus block in velocity of 2 ml/h, and its maintenance time was 48 h. The effect of separating brachial plexus block at 1, 2, 3, 6 and 12 h after finishing brachial plexus block was compared. The VAS, Ramesay assessment scoring were recorded at 0, 12, 24 and 48 h after starting pump.
  
  
  RESULTS
  In each group, the effect of motor block became greater in the ascending order from 1, 2 to 3 h after finishing brachial plexus block, and less in the descending order from 3, 6 to 12 h after finishing brachial plexus block. Only at 6 and 12 h after finishing brachial plexus block, the effect of motor block of group B and group C was significantly less than that of group A (P < 0.05, < 0.01), the effect of motor block of group C was less than that of group B (P > 0.05). The effect of sensory block in the patients of all 3 groups was satisfactory. The VAS, Ramesay assessment scoring, effect of analgesia and sedation at 24 and 48 h after starting pump became greater in the ascending order from group A to group C, in which group B and group C were significantly greater than group A (P < 0.01).
  
  
  CONCLUSIONS
  The separating brachial plexus block combined with preoperative analgesia by 2 kinds of PCIA dispensation can be both applied in tendon repair, but the separating effect of brachial plexus block of group B was superior to the group C.
authors.affiliation: Department of Hand Surgery, People's Liberation Army 401st Hospital, Qingdao 266071, China.
authors.forename: Yuan-xin
authors.initials: YX
authors.lastname: Zhang
authors.forename: Shu-jian
authors.initials: SJ
authors.lastname: Hou
authors.forename: Zhen-jun
authors.initials: ZJ
authors.lastname: Wang
authors.forename: Xian-bin
authors.initials: XB
authors.lastname: Meng
authors.forename: Qin
authors.initials: Q
authors.lastname: Zhang
authors.forename: Hai-ling
authors.initials: HL
authors.lastname: Zhang
authors.forename: Ying
authors.initials: Y
authors.lastname: Xu
authors.forename: Chun-min
authors.initials: CM
authors.lastname: Wu
authors.forename: De-ming
authors.initials: DM
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D001917:Brachial Plexus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010149:Postoperative Pain / Q000517:prevention & control*; D013710:Tendons / Q000601:surgery*