title: Improved sensory relearning after nerve repair induced by selective temporary anaesthesia - a new concept in hand rehabilitation.
abstract: The outcome after nerve repair in adults is generally poor. We hypothesized that forearm deafferentation would enhance the sensory outcome by increasing the cortical hand representation. A prospective, randomized, double-blind study was designed to investigate the effects of cutaneous forearm anaesthesia combined with sensory re-education on the outcome after ulnar or median nerve repair. During a 2 week period, a local anaesthetic cream (EMLA (n = 7) or placebo (n=6) was applied repeatedly onto the flexor aspect of the forearm of the injured arm and combined with sensory re-education. Evaluation of sensory function was carried out at regular intervals and at 4 weeks after the last EMLA/placebo session. The EMLA group showed significant improvement compared to placebo in perception of touch/pressure, tactile gnosis and in the summarized outcome after 6 weeks. These results suggest that cutaneous forearm anaesthesia of the injured limb, in combination with sensory re-education, can enhance sensory recovery after nerve repair.
authors.affiliation: Department of Hand Surgery, Lund University, University Hospital Malmö, Sweden. birgitta.rosen@med.lu.se
authors.forename: B
authors.initials: B
authors.lastname: Rosén
authors.forename: A
authors.initials: A
authors.lastname: Björkman
authors.forename: G
authors.initials: G
authors.lastname: Lundborg
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005542:Forearm / Q000294:innervation / Q000601:surgery; D006225:Hand / Q000294:innervation* / Q000503:physiopathology; D006801:Humans; D007858:Learning; D008012:Lidocaine / Q000627:therapeutic use*; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008475:Median Nerve / Q000293:injuries / Q000601:surgery; D008875:Middle Aged; D009473:Neuronal Plasticity; D010465:Perception / Q000187:drug effects*; D011318:Prilocaine / Q000627:therapeutic use*; D011446:Prospective Studies; D012677:Sensation / Q000187:drug effects*; D012678:Sensation Disorders / Q000503:physiopathology / Q000534:rehabilitation*; D012867:Skin / Q000187:drug effects / Q000294:innervation*; D014110:Touch / Q000502:physiology*; D014459:Ulnar Nerve / Q000293:injuries / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine