Abstract
The patient was a 49-year-old male undergoing artificial dialysis and treatment with anticoagulant and antiplatelet agents. The blood flow of his right forearm was reduced as a result of peripheral arterial disease. Although he had undergone brachial-radial artery bypass and ulnar artery dilation surgery, the ischemia of the 4th and 5th right fingers was progressing to necrosis. The ischemic pain was very severe, especially during dialysis. We implemented right ulnar nerve block with single bolus doses just before dialysis, and the patient achieved a pain-free state for several hours. We inserted a catheter near the ulnar nerve at the patient's forearm under ultrasound guidance. When we initiated continuous injection of local anesthetic, the finger pain was reduced immediately. We managed to achieve pain control with ropivacaine administration via the catheter during amputation of the fingers. We managed the postoperative pain and the pain accompanying wound treatment after surgery. The duration of catheterization was fifty-two days.
