Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers

Microsurgical operations of the hand are common procedures of reconstructive surgeons. Sympathetic blockade of the vessels provides increased blood flow to the injured extremity, which increases the success rate of the surgery. Moreover, postoperative pain management can be performed with continuous blockade of the nerves. In this article, the effect of continuous brachial plexus blockade on patients who underwent upper extremity microsurgical operation was evaluated. A total of 16 patients were operated on either for replantation or for toe-to-hand transfer. The first group (n = 9) received combined continuous brachial plexus blockade and general anesthesia, and postoperative pain management was performed with continuous brachial plexus blockade. The remaining 7 patients operated on general anesthesia and conventional pain management. All transplant and replants were followed by use of Doppler flowmeter. Pain was scored by visual analog scale every 4 hours postoperatively. Continuous brachial plexus blockade was found to be effective in both sympathetic blockade and postoperative pain management. Continuous brachial plexus blockade must be considered when microvascular anastomosis is performed at the upper extremity, especially at the digital vessels, which are very susceptible to vasospasm.