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首页> 外文期刊>Journal of Clinical Medicine Research >Bilateral Brachial Plexus Home Going Catheters After Digital Amputation for Patient With Upper Extremity Digital Gangrene
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Bilateral Brachial Plexus Home Going Catheters After Digital Amputation for Patient With Upper Extremity Digital Gangrene

机译：上肢数字性坏疽患者数字截肢后双侧臂丛神经回家导管

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Peripheral nerve catheter placement is used to control surgical pain. Performing bilateral brachial plexus block with catheters is not frequently performed; and in our case sending patient home with bilateral brachial plexus catheters has not been reported up to our knowledge. Our patient is a 57 years old male patient presented with bilateral upper extremity digital gangrene on digits 2 through 4 on both sides with no thumb involvement. The plan was to do the surgery under sequential axillary blocks. On the day of surgery a right axillary brachial plexus block was performed under ultrasound guidance using 20 ml of 0.75% ropivacaine. Patient was taken to the OR and the right fingers amputation was carried out under mild sedation without problems. Left axillary brachial plexus block was then done as the surgeon was closing the right side, two hours after the first block was performed. The left axillary block was done also under ultrasound using 20 ml of 2% mepivacaine. The brachial plexus blocks were performed in a sequential manner. Surgery was unremarkable, and patient was transferred to post anesthetic care unit in stable condition. Over that first postoperative night, the patient complained of severe pain at the surgical sites with minimal pain relief with parentral opioids. We placed bilateral brachial plexus catheters (right axillary and left infra-clavicular brachial plexus catheters). Ropivacaine 0.2% infusion was started at 7 ml per hour basal rate only with no boluses on each side. The patient was discharged home with the catheters in place after receiving the appropriate education. On discharge both catheters were connected to a single ON-Q (I-flow Corporation, Lake Forest, CA) ball pump with a 750 ml reservoir using a Y connection and were set to deliver a fixed rate of 7 ml for each catheter. The brachial plexus catheters were removed by the patient on day 5 after surgery without any difficulty. Patient's postoperative course was otherwise unremarkable. We concluded that home going catheters are very effective in pain control postoperatively and they shorten the period of hospital stay.doi:10.4021/jocmr645w
机译：周围神经导管的放置用于控制手术疼痛。不经常用导管进行双侧臂丛神经阻滞。在我们的案例中，据我们所知，尚无报道使用双侧臂丛神经导管将患者送回家。我们的患者是一位57岁的男性患者，双侧上肢数字坏疽在第2到第4位数字上出现，没有拇指受累。计划是在连续腋窝阻滞下进行手术。在手术当天，在超声引导下，使用20 ml的0.75％罗哌卡因进行右腋臂臂丛神经阻滞。将患者带到手术室，在轻度镇静下进行右手指截肢，没有问题。然后，当外科医生关闭右侧时，在完成第一个阻滞后两个小时进行左腋臂丛神经阻滞。左腋窝阻滞也是在超声检查中使用20 ml 2％甲哌卡因进行的。臂丛神经阻滞是按顺序进行的。手术效果不明显，患者被转移到麻醉后的病房，病情稳定。在术后的第一个晚上，患者主诉手术部位的剧烈疼痛，而父母用阿片类药物缓解的疼痛最小。我们放置了双侧臂丛神经导管（右腋窝和左锁骨下臂丛神经导管）。罗哌卡因0.2％输注开始时以每小时7毫升的基本速率开始，每侧均不推注。接受适当的教育后，患者就诊，导管就位。排放时，将两个导管通过Y型连接连接到具有750 ml储液器的单个ON-Q（I-flow Corporation，Lake Forest，CA）球泵，并设置为每个导管以7 ml的固定速率输送。病人在手术后第5天移除臂丛神经导管，没有任何困难。否则患者的术后病程并不明显。我们得出的结论是，回肠导管对术后疼痛的控制非常有效，并且可以缩短住院时间。doi：10.4021 / jocmr645w

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