Pain and efficacy rating of a microprocessor-controlled metered injection system for local anaesthesia in minor hand surgery.

Purpose. Little attention has been given to syringe design and local anaesthetic administration methods. A microprocessor-controlled anaesthetic delivery device has become available that may minimize discomfort during injection. The purpose of this study was to document the pain experience associated with the use of this system and to compare it with use of a conventional syringe. Methods. A prospective, randomized clinical trial was designed. 40 patients undergoing carpal tunnel release were block randomized according to sex into a two groups: a traditional syringe group and a microprocessor-controlled device group. The primary outcome measure was surgical pain and local anaesthetic administration pain. Secondary outcomes included volume of anaesthetic used and injection time. Results. Analysis showed that equivalent anaesthesia was achieved in the microprocessor-controlled group despite using a significantly lower volume of local anaesthetic (P = .0002). This same group, however, has significantly longer injection times (P < .0001). Pain during the injection process or during surgery was not different between the two groups. Conclusions. This RCT comparing traditional and microprocessor controlled methods of administering local anaesthetic showed similar levels of discomfort in both groups. While the microprocessor-controlled group used less volume, the total time for the administration was significantly greater.

Nerve reconstruction in the hand and upper extremity.

In the management of traumatic peripheral nerve injuries, the severity or degree of injury dictates the decision making between surgical management versus conservative management and serial examination. This review explores some of the recent literature, specifically addressing recent basic science advances in end-to-side and reverse end-to-side recovery, Schwann cell migration, and neuropathic pain. The management of nerve gaps, including the use of nerve conduits and acellularized nerve allografts, is examined. Current commonly performed nerve transfers are detailed with focus on both motor and sensory nerve transfers, their indications, and a basic overview of selected surgical techniques.

Compression neuropathy of the peroneal nerve secondary to a ganglion cyst.

Peripheral neuropathies caused by ganglion cysts are rare, particularly in the lower extremities. The case of a 45-year-old man with a two-month history of foot drop and swelling in the region of the right fibular head is presented. Physical examination and electromyogram studies verified a peroneal nerve palsy. Magnetic resonance imaging revealed a lobulated, multilocular, cystic-appearing mass extending around the fibular neck. Surgical decompression of the nerve with removal of the mass and careful articular branch ligation was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. The patient regained full function within four months of the decompression. Pertinent findings on physical examination are discussed, as well as electromyogram and magnetic resonance imaging results. If symptoms persist, early surgical decompression (between the third and fourth months) is recommended.

Steroid injections in the management of trigger fingers.

OBJECTIVES: The most commonly used primary treatment for trigger fingers is corticosteroid injection in the flexor tendon sheath, followed by surgical release if unsuccessful. This study examines the surgical and nonsurgical treatment of patients with trigger fingers presenting to a large Canadian tertiary referral center. The treatment success and side-effect profile of steroid injection therapy and surgical release were examined in the context of comorbid illness, specifically, diabetes mellitus. DESIGN: Retrospective review of all patients with trigger finger who were seen by the senior authors between January 1999 and June 2004. RESULTS: In the study period, 118 trigger digits were treated. This study included 92 nondiabetic, 21 type 2 diabetic, and five type 1 diabetic trigger fingers. Of the 89 digits that received at least one steroid injection, 46 (52%) resolved completely and 42 (47%) were improved. Nondiabetic digits were treated successfully in 40 out of 70 digits (57%) with steroid injection therapy. Diabetic patients had a success rate of 6 of 19 (32%) with steroid injections, which is significantly lower than nondiabetics (P = 0.04). All type 1 diabetics (n = 5) required surgical treatment. Surgical treatment was successful in 71 of 72 (99%) digits. No side effects of steroid injection were noted, and short-term postoperative side effects were noted in 26 of 72 surgical patients (36%). No statistically significant differences were found in surgical complication rates in diabetics vs. nondiabetics or type 1 diabetics vs. type 2 diabetics. CONCLUSIONS: Steroid injection therapy should be the first-line treatment of trigger fingers in nondiabetic patients. In diabetics, the success rate of steroid injection is significantly lower. Injection therapy for type 1 diabetics was ineffective in this study. Surgical release of the first annular (A1) pulley is most effective overall in diabetics and nondiabetics alike, with no higher rates of surgical complications in diabetics.