Targeted Ultrasound-Guided Double Catheters (Infraclavicular-Brachial Plexus, Median Nerve) Facilitate Hand Rehabilitation with Superb Analgesia and Motor Function Retention

摘要

A 44-year-old male who suffered a crush-degloving hand injury complicated by Complex Regional Pain Syndrome (CRPS) type I was scheduled for operative hand manipulation and inpatient physiotherapy. Preoperative placement of an ultrasound-guided infraclavicular catheter provided incomplete analgesia requiring supplemental morphine during physiotherapy sessions despite continuous infusion of 0.1% bupivacaine at 20 mL/hour. Due to the patient’s adamant refusal of replacement of the infraclavicular catheter, a second ultrasound-guided median nerve catheter was placed distally at the mid-forearm level and elicited complete sensory blockade of the hand. Dual infusions were maintained with 0.25% bupivacaine at 5 mL/hour through the median nerve catheter and 0.1% bupivacaine at 20 mL/hour through the infraclavicular catheter, and subsequent daily physiotherapy progressed productively. Continuous perineural catheter use to facilitate rehabilitation is an emerging practice that may improve overall recovery. Combination catheters, infusing local anesthetics at separate locations, can be used synergistically to preserve motor function and reach a superior analgesic endpoint.