[Ultrasound-guided selective nerve blocks for trigger finger surgeries to maintain flexion/extension of fingers - Case series]

Abstract

Background: A patient's ability to move his/her fingers during hand surgery may be helpful to surgeons because it allows the effectiveness of the intervention evaluation and prediction of hand function in the postoperative period. The purpose of this case series is to demonstrate the efficacy of an ultrasound-guided peripheral nerve block technique to maintain the hand flexor and extensor muscles motor function and discuss the benefits of the technique for trigger finger surgery.

Case report: Ten patients scheduled to undergo trigger finger surgery were selected. The goal was to maintain flexion and extension of the fingers during the procedure. Thus, ultrasound-guided ulnar, radial, and medial nerve block was performed in the distal third of the forearm, at 5–7 cm proximal to the wrist. The block was performed with 5 mL of 0.375% bupivacaine on each nerve. All procedures were uneventfully performed maintaining the flexion and extension of the fingers. In two cases, it was observed that the motricity maintenance and the patients’ ability to move their fingers when requested allowed the success of the surgical procedure after the third intraoperative evaluation.

Conclusion: This case series shows that it is possible to maintain the motor function of the hand flexor and extensor muscles to perform finger trigger surgeries using specific ultrasound-guided distal blocks.

Keywords: Bloqueios seletivos; Flexion and extension of the fingers; Flexão e extensão dos dedos; Liberação dedo em gatilho; Selective nerve blocks; Trigger finger release; Ultrasound; Ultrassom.

Figure 1

Relationship between the median, ulnar, and radial nerves with the flexor muscles of the hand in the anterior region of the forearm. It is observed that the proximal third of the forearm muscles, the portion that receives the motor nerve endings, is proximal to the anesthetic site, which is made in the distal part of the forearm.

Figure 2

Relation between median, ulnar, and radial nerves with the hand extensor muscles in the forearm posterior region. It is observed that the proximal third of the forearm muscles, the portion that receives the motor nerve endings, is proximal to the anesthetic site, which is made in the distal part of the forearm.