Ultrasound guided Brachial Plexus Catheter for Upper Limb Digit Reimplantation Surgeries: A Retrospective Analysis of One Year in a Tertiary Trauma Center.

Abstract

Introduction: Most traumatic digital amputations occur at a young age and the treatment options are revascularization, replantation of the amputated segment, or stump closure. Anesthesia management in these patients plays a major role, including the insertion of a brachial plexus catheter for adequate pain control and vasodilation. Use of ultrasound not only reduces incidence of complications but also enhances success rate. Methods: After approval from the Clinical Audit & Control Department, a retrospective analysis was performed in all patients who underwent digit reimplantation surgeries in 2022. Brachial plexus catheters were inserted intraoperatively under general anesthesia or after extubation in the Post Anesthesia Care Unit (PACU). All brachial plexus catheterization was performed under dual guidance (ultrasound + peripheral nerve stimulator).  Results: A total of 46 patients underwent digit reimplantation surgery in the year 2022, and the supraclavicular catheter was the most preferred site of catheter insertion in 37 patients (80%). Five patients (11%) developed catheter related complications, which were detected early and managed accordingly. In our case series, a success rate of 70% was found, while a failure rate of 22%, where the end point was amputations. Conclusion: Insertion of a brachial plexus catheter in digit reimplantation surgery resulted in better outcomes. It helps counter pain induced vasoconstriction and leads to vasodilation, improving the peripheral circulation.

Keywords: Traumatic amputation, reimplantation, continuous brachial plexus catheter, ultrasound guided, survival of digits.