Application Of Ultrasound-guided Stellate Ganglion Block After Replantation Of Severed Fingers

Objectlive:To observe the effect of ultrasound-guided stellate ganglion block on the survival rate,vascular crisis and adverse reaction of replanted finger after replantation of severed finger.Methods:With the approval of the Ethics Committee,60 ASA Ⅰ-Ⅱ emergency hand surgery patients were randomly divided into two groups,30 cases in the observation group and 30 cases in the control group.Both groups were anesthetized with ultrasound-guided intermuscular sulcus approach for brachial plexus block and 0.35%ropivacaine hydrochloride 20 ml for local anesthesia.The patients in the control group were not given any other special treatment after operation.The patients in the observation group were punctured and placed on the surface of the musculus longus longus at the level of C6 transverse process under the guidance of ultrasound immediately after operation.The patients in the observation group were subjected to continuous stellate ganglion block with extermal electronic infusion pump(0.2%ropivacaine hydrochloride 150ml,loading 3ml,background infusion dose 2ml/h).For three days.The sign of success is the occurrence of Homer’s syndrome.The radial artery perfusion index,palmar temperature of affected forearm,incidence of vascular crisis and other adverse reactions were compared between the two groups at 1,24,48 and 72 hours after operation.Results:There was no significant difference between the two groups in age,sex,height,body mass index,type and manner of operation,operation time and so on.The radial artery perfusion index of the affected side was higher than that of the control group at 1 h,24 h,48 h and 72 h after operation(P<0.05),the palmar temperature of the affected side was higher than that of the control group(P<0.05),and the vascular crisis occurred in 3 cases in the control group and no blood in the observation group(P<0.05).There were no other adverse reactions in the two groups.Survival rate comparison:observation group replanted 30 fingers,survived 30 fingers,the survival rate was 100%;control group replanted 30 fingers,survived 26 fingers,the survival rate was 86.6%.The survival rate of the replantation fingers in the observation group was higher than that in the control group.Conclusions:Continuous stellate ganglion block guided by ultrasound within 72 hours after replantation of severed finger can effectively improve the index of blood perfiision and palm temperature of affected finger by blocking cervicothoracic sympathetic ganglion,prevent the occurrence of vascular crisis after replantation,and improve the survival rate of repalanted finger.It has high clinical value.