Analgesia with continuous axillary block after surgery for severe hand trauma: self-administration versus continuous injection.

Objective: To compare analgesia produced after surgery for severe hand trauma, by a continuous axillary block obtained either with a continuous injection (CA) or controlled by the patient (PCA). Study design: Prospective, randomized study. Patients: Forty-two ASA physical class 1 and 2 patients were enrolled over a twelve-month period and randomly allocated either into the CA or the PCA group. Methods: After recovery from the surgical block, the axillary plexus was located using a nerve stimulator and a 20 G catheter (Contiplex(TM) B Braun) inserted over 5 centimeters into the axillary sheath, in the CA group (n = 21) patients received 0.1 mL.kg(-1).h(-1) of 0.25 % bupivacaine and in the PCA group (n = 21) patients received 0.1 mL.kg(-1) boluses of 0.25% bupivacaine with a one hour lock-out period. Data collected were pain intensity rated according to he visual analog scale (VAS), the total volume of bupivacaine injected, the quantity of nalbuphine administered as 10 mg boluses when VAS was = 5, and the patient's satisfaction after removal of the catheter. Statical analysis used Student t test, ANOVA and chi(2) test. Results: The mean duration of catheter use was 5 +/- 3 days. During this period the amount of bupivacaine was significantly reduced in the PCA group when compared to the CA group (P < 0.001). Similarly, the PCA group requiered significantly less nalbuphine. Finally, in this group, the satisfaction index was higher than in the CA group (95 versus 52 % respectively, P < 0.01). Conclusion: Continuous axillary plexus blockade provides safe and effective postoperative analgesia. With the PCA technique results a lower quantity of bupivacaine is required and patient's satisfaction better. (C) 1998 Elsevier, Paris.