Clinical evaluation of modified transthecal digital block and traditional dorsal digital block techniques for hand injury of adults in emergency

doi:10.3969/j.issn.2095-4344.2015.15.012

Abstract

Abstract:

BACKGROUND: Dorsal digital block refers to the commonly used anesthesia for adults in small or moderate hand injury surgeries, but in recent years, modified transthecal digital block technique is gradually respected, which is favored with a rapid and good effect and fewer complications.
OBJECTIVE: To evaluate the clinical anesthetic outcomes of modified transthecal digital block and traditional dorsal digital block technique for the treatment of hand injury of adults in emergency by a prospective randomized controlled study.
METHODS: Totally 60 adult patients with hand injury were enrolled and divided into two groups of modified transthecal digital block and traditional dorsal digital block randomly. Blocks were performed by one single surgeon. The operation time, local anesthetic dose, onset time of anesthesia, duration of anesthesia, success rate of anesthesia, visual analogue scale scores and complications were recorded.
RESULTS AND CONCLUSION: The anesthesia effects in the two groups were acceptable. There was no significant difference in the onset time of anesthesia, duration of anesthesia, success rate of anesthesia and complications between the two groups (P > 0.05). The operation time of anesthesia, local anesthetic dose, and visual analogue scale scores were significantly different between the two groups (P < 0.05). Modified transthecal digital block is more convenient and has less pain than the traditional root digital block, which is a safe and reliable anesthetic technique.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

全文链接：

Key words: Anesthesia, Fingers, Hand Injuries

CLC Number:

R318

Lu Ye, Gu Wen-qi, Cai Pei-hua, Li Yan-feng, Zhan Yu-lin, Chai Yi-min. Clinical evaluation of modified transthecal digital block and traditional dorsal digital block techniques for hand injury of adults in emergency[J]. Chinese Journal of Tissue Engineering Research, 2015, 19(15): 2356-2360.

Figures/Tables 1

2.1 参与者数量分析纳入患者60例，分为2组，按意向性处理分析，全部进入结果分析。 2.2 两组患者基线资料比较两组患者基线资料及患指分布情况见表1；随机分组流程图见图1。 2.3 两组病例临床治疗效果改良腱鞘内麻醉组30例，优26例，良2例，中2例，差0例，麻醉成功率93.3%，随访1例为中指屈肌腱轻度粘连，经功能锻炼后好转，随访无麻醉部位持续疼痛、无注射点感染、无腱鞘感染、肌腱自发断裂、血管神经损伤、无指端缺血坏死等并发症。指根麻醉组30例，优25例，良4例，中1例，差0例，优良率96.7%，麻醉术中，2例出现误穿刺入血管，随访并发症1例，环指屈肌腱轻度粘连，经功能锻炼后好转，无麻醉部位持续疼痛、无注射点感染、无腱鞘感染、肌腱自发断裂、无指端缺血坏死等并发症。两组病例临床效果情况详见表2。 2.4 不良反应两组所有患者获得术后2周门诊随访，术后1，6个月电话随访，其中改良屈肌腱鞘内麻醉组6例术后24 h，术后3 d自行外院换药，指根麻醉组5例，术后24 h、术后3 d自行外院换药，但所有患者接受术后2周门诊随访，1，6个月电话随访，平均随访时间6月。随访病例3例(改良腱鞘内麻醉组1例，指根麻醉组2例屈肌腱轻度粘连，活动受限，考虑本身肌腱修补后制动引起粘连，功能锻炼后活动满意；随访无注射点感染、无腱鞘感染、肌腱自发断裂、血管神经损伤无指端缺血坏死等并发症。 2.5 典型病例患者男性45岁，左再造示指撕裂伤。18年前外院行示指再造术，通常单侧血管吻合，已无法确认桡侧还是尺侧吻合指固有动脉，随机入改良屈指腱鞘内麻醉组，麻醉成功，缝合术后指端血运良好，无血管神经等损伤。见图2。"

References

[1] Braun HH. Operation on the extremities. In Local anesthesia: its scientific basis and practical use, 2nd American edition from the 6th revised German edition. Philadelphia: Lea and Febiger.1914: 367.
[2] Chiu DT. Transthecal digital block: flexor tendon sheath used for anesthetic infusion. J Hand Surg.1990; 15(3): 471-477.
[3] Whetzel TP, Mabourakh S, Barkhordar R. Modified transthecal digital block. J Hand SURG Am.1997; 22(2): 361-363.
[4] Torok PJ, Flinn SD, Shin AY. Transthecal digital block at the proximal phalanx. J Hand Surg.2006; 26(1): 69-71.
[5] Hart RG, Fernandas FA, Kutz JE. Transthecal digital block: an underutilized technique in the ED. Am J Emerg MED.2005; 23(3): 340-342.
[6] 徐海锦,曹培红.屈指肌腱鞘管内麻醉215例(237指)分析[J]．中国误诊学杂志,2008,8(17):4139．
[7] 夏秀春,马晓泉.屈指肌腱鞘管阻滞麻醉效果分析[J].临床医药实践,2012,21(10)：749-750．
[8] 曾本强,李红,罗凌云.手指腱鞘内麻醉与腱鞘外麻醉效果比较[J].国际骨科学杂志,2011,32(4):267-271．
[9] Egekvist H, Bjerring P, Arendt-Nielsen L. Pain and mechanical Injury of human skin following needle insertions. EUR J Pain, 1999;3(1): 41-49.
[10] Martires KJ, Malbasa CL, Bordeaux JS. A randomized controlled crossover trial Lidocaine injected at a 90-degree angle causes less pain than lidocaine injected at a 45-degree angle. J Am ACAD Dermatol.2011; 65(6): 1231-1233.
[11] Zilinsky I, Bar-Meir E, Zaslansky R,et al. Ten commandments for minimal pain during administration of local anesthetics. J Drugs Dermatol.2005; 4(2): 212-216.
[12] Tzeng YS, Chen SG.. Tumescent technique in digits a subcutaneous single-injection digital block. Am J Emerg Med. 2012;30(4):592-596.
[13] Williams JG, Lalonde DH.. Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plast Reconstr Surg.2006; 118(5): 1195-1200.
[14] Wheelock ME, Leblanc M, Chung B, .et al. Is it true that injecting palmar finger skin hurts more than dorsal skin? New level 1 evidence. Hand (N Y), 2011;6(1): 47-49.
[15] Waitayawinyu T, Dodds SD, Niempoog S. Dose effectiveness of transthecal digital block. J Hand Surg Am.2009; 34(3): 458-462.
[16] Krause RS, Moscati R, Filice M,et al.The effect of injection speed on the pain of lidocaine infiltration. ACAD Emerg MED, 1997; 4(11): 1032-1035.
[17] Hamelin ND, St-Amand H, Lalonde DH, et al. Decreasing the pain of finger block injection level II evidence. Hand (New York, N.Y.).2013; 8(1): 67-70.
[18] Whitworth JM, Kanaa MD, Corbett IP, et al.Influence of injection speed on the effectiveness of incisive/mental nerve block: a randomized, controlled, double-blind study in adult volunteers. J Endod.2007; 33(10): 1149-1154.
[19] 赵海燕.不同浓度罗哌卡因屈肌腱鞘管内麻醉的安全性比较_赵海燕[J].中国现代药物应用,2014,8(9):117-119．
[20] Cepeda MS, Tzortzopoulou A, Thackrey M, et al.. Adjusting the pH of lidocaine for reducing pain on injection. Cochrane Database Syst Rev. 2010 Dec 8;(12):CD006581.
[21] Vance JC. Anesthesia.//Roenigk RK, Roenigk HH, editors. Dermatologic Surgery, Principles and Practice. 2nd ed. New York, NY: Marcel Decker Inc; 1996:31-52.
[22] MacFarlane DF, Scher RK. Nail surgery.//Ratz JL, editors. Textbook of Dermatologic Surgery. 1st ed. Philadelphia, PA: Lippincot-Raven. 1998:621-630.
[23] Sonohata M, Nagamine S, Maeda K,et al. Subcutaneous single injection digital block with epinephrine. Anesthesiol Res Pract.2012;2012:487650.
[24] Krunic AL, Wang LC, Soltani K, et al. Digital anesthesia with epinephrine An old myth revisited. J Am ACAD Dermatol, 2004; 51(5):755-779.
[25] Finsen V. Necrosis in fingers and toes following local anaesthesia with adrenaline-an urban legend? Tidsskr Nor Laegeforen. 2013;133(17):1827-1830
[26] Lalonde D, Martin A.Epinephrine in local anesthesia in finger and hand surgery: the case for wide-awake anesthesia.J Am Acad Orthop Surg.2013;21(8):443-447.
[27] Lalonde DH, Lalonde JF.Discussion: Do Not Use Epinephrine in Digital Blocks: Mythor Truth? Part II. A Retrospective Review of 1111 Cases. Plast Reconstr Surg. 2010; 126(6): 2035-2036.