title: Enhanced sensory relearning after nerve repair by using repeated forearm anaesthesia: aspects on time dynamics of treatment.
abstract: BACKGROUND
  We describe a new principle for enhancing the effects of sensory re-education following nerve injury and repair. The outcome from nerve repair in adult patients is generally poor. One reason is the functional cortical reorganisation which always occurs because of axonal misdirection at the repair site. In healthy individuals selective anaesthesia of the forearm results in improved hand sensation. Here we hypothesised that this principle would be valid also after nerve injury and repair.
  
  
  METHODS
  In a prospective, randomised, double blind study we studied the effects of cutaneous forearm anaesthesia combined with sensory reeducation on the outcome after median or ulnar nerve repair at wrist or distal forearm level.
  
  
  RESULTS
  EMLA-application four times over a two week period starting with beginning reinnervation of the fingers resulted in significantly improved sensory recovery (tactile gnosis) as compared to the placebo group and also at assessment four weeks after the last EMLA-session. However, at assessment 8-11 months after the first EMLA-treatment there was no difference between the groups.
  
  
  CONCLUSIONS
  Our findings indicate that repeated cutaneous forearm anaesthesia over a two week period can enhance the effects of sensory re-education at least over the four following weeks. However, the optimal time protocol for EMLA-treatment, aiming at a long-lasting or permanent effect on sensory recovery still has to be defined.
authors.affiliation: Department of Clinical Sciences/Hand Surgery, Malmö University Hospital, Malmö, Sweden. goran.lundborg@med.lu.se
authors.forename: G
authors.initials: G
authors.lastname: Lundborg
authors.forename: A
authors.initials: A
authors.lastname: Björkman
authors.forename: B
authors.initials: B
authors.lastname: Rosén
mesh_terms: D000328:Adult; D000368:Aged; D000772:Anesthesia, Local; D000779:Anesthetics, Local; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D005542:Forearm; D006801:Humans; D007858:Learning; D008012:Lidocaine; D000077442:Lidocaine, Prilocaine Drug Combination; D008297:Male; D008475:Median Nerve / Q000293:injuries* / Q000601:surgery; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000534:rehabilitation*; D011318:Prilocaine; D020127:Recovery of Function; D012677:Sensation; D012867:Skin; D014110:Touch; D014459:Ulnar Nerve / Q000293:injuries* / Q000601:surgery; D014947:Wounds and Injuries / Q000601:surgery; D014953:Wrist / Q000294:innervation
chemical_list: D000779:Anesthetics, Local; D000077442:Lidocaine, Prilocaine Drug Combination; D011318:Prilocaine; D008012:Lidocaine