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 titlePlastic and reconstructive surgery. Global open
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 KluwerHealth, Inc. on behalf of The American Society of Plastic Surgeons.All rights reserved. This is an open-access article distributed underthe 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 downloadand share the work provided it is properly cited. The work cannotbe 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
DOIinfo:doi/10.1097/GOX.0000000000000365
Collection (particular)国立国会図書館デジタルコレクション > デジタル化資料 > 博士論文
Date Accepted (W3CDTF)2017-02-09T20:08:30+09:00
Data Provider (Database)国立国会図書館 : 国立国会図書館デジタルコレクション