title: Ultrasound-guided Selective Sensory Nerve Block for Wide-awake Forearm Tendon Reconstruction.
abstract: BACKGROUND
  Wide-awake hand surgery is useful for tendon reconstruction because surgeons can observe the actual movement of the reconstructed tendons during the surgery. We hypothesized that accurate ultrasound-guided injection of local anesthetics into the sensory nerves contributes to reliable analgesia with a relatively small amount of anesthetic.
  
  
  METHODS
  We enrolled 8 patients who underwent forearm tendon transfer. Three patients underwent reconstruction of flexor tendon ruptures in zones 4 and 5, 3 underwent opponensplasty, and 2 underwent multiple tendon transfers according to Brand's procedure. All patients underwent ultrasound-guided injection of ropivacaine to each sensory nerve branch of the upper arm and forearm and into the subfascial layer of the forearm. The mean amount of total ropivacaine was 193 mg.
  
  
  RESULTS
  In 7 of the 8 patients, we confirmed adequate active contraction of the flexor or extensor muscles during surgery. The expected active motion of the flexor pollicis longus was not found in 1 patient during surgery because the effect of the anesthetic had spread too widely, involving the motor branch of the median nerve. Two patients required additional infiltration of 2-3 mL of local anesthetic because of local wound pain. All patients gained satisfactory function of the transferred tendons after the surgery, and no remarkable perioperative complications related to local anesthetic systemic toxicity occurred.
  
  
  CONCLUSIONS
  Selective administration of an anesthetic to the sensory nerve branches and subfascial layer enables the performance of wide-awake forearm tendon surgery. The ultrasound-guided injection technique provides safe and effective regional anesthesia for wide-awake surgery.
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Nakanishi
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Omokawa
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Kobata
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Takamasa
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kira
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Tadanobu
authors.initials: T
authors.lastname: Onishi
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Hayami
authors.affiliation: Department of Orthopedic Surgery, Nara Medical University, Nara, Japan.
authors.forename: Yasuhito
authors.initials: Y
authors.lastname: Tanaka