Ultrasound-guided Selective Sensory Nerve Block for Wide-awake Forearm Tendon Reconstruction.

• Material Type: 博士論文
• Title: Ultrasound-guided Selective Sensory Nerve Block for Wide-awake Forearm Tendon Reconstruction.
• Author/Editor: Nakanishi, Yasuaki; Omokawa, Shohei; Kobata, Yasunori; Shimizu, Takamasa; Kira, Tsutomu; Onishi, Tadanobu; Hayami, Naoki; Tanaka, Yasuhito
• Author Heading: Nakanishi, Yasuaki; Omokawa, Shohei; Kobata, Yasunori; Shimizu, Takamasa; Kira, Tsutomu; Onishi, Tadanobu; Hayami, Naoki; Tanaka, Yasuhito
• Publication, Distribution, etc.: Wolters Kluwer Health/Lippincott Williams & Wilkins
• Publication Date: 2015-06-05
• Publication Date (W3CDTF): 2015-06-05
• Alternative Title: 超音波ガイド下選択的知覚神経ブロックによる、前腕健機能再建のためのwide-awake surgery
• Periodical title: Plastic and reconstructive surgery. Global open
• No. or year of volume/issue: 3 5
• Volume: 3
• Issue: 5
• Pages: Article No.e392-
• ISSN (Periodical Title): ISSN : 2169-7574
• Degree grantor/type: 奈良県立医科大学
• Date Granted: 2016-11-24
• Dissertation Number: 甲第659号
• Degree Type: 博士（医学）
• Text Language Code: und
• Target Audience: 一般
• Note (General): type:Thesis; 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.; 博士（医学）・甲第659号・平成28年11月24日; Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial NoDerivatives 3.0 License(https://creativecommons.org/licenses/by-nc-nd/3.0/), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.; identifier:Plastic and reconstructive surgery. Global open Vol.3 No.5 Article No.e392 (2015 Jun); identifier:21697574; identifier:http://ginmu.naramed-u.ac.jp/dspace/handle/10564/3287; identifier:Plastic and reconstructive surgery. Global open, 3(5): Article No.e392
• Access Restrictions: インターネット公開
• Related Material (DOI): 10.1097/GOX.0000000000000365
• Data Provider (Database): 国立情報学研究所 : 学術機関リポジトリデータベース（IRDB）（機関リポジトリ）; https://irdb.nii.ac.jp
• Original Data Provider (Database): 奈良県立医科大学 : 奈良県立医科大学機関リポジトリ GINMU

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http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3287/1/01_%e7%94%b2659%e6%9c%ac%e6%96%87%e3%81%ae%e8%a6%81%e6%97%a8.pdf fulltext

http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3287/2/02_%e7%94%b2659%e5%af%a9%e6%9f%bb%e8%a6%81%e6%97%a8.pdf fulltext

http://ginmu.naramed-u.ac.jp/dspace/bitstream/10564/3287/14/03_%e7%94%b2659%e6%9c%ac%e6%96%87.pdf fulltext