Continuous Brachial Plexus Blockade for Replantation of an Amputated Finger by Dog Bite - A Case Report

Abstract

A 53-year-old woman presented with complete left index finger amputation in zone Ⅳ caused by a dog bite. The finger was replanted; two digital arteries and two veins were sutured after thorough debridement and irrigation. The patient started receiving prostaglandin E1 after the surgery; however, her finger turned from a pinkish color to a whitish color because of vasospasm within the first 10 hours. In order to treat brachial plexus block, we administered 1% lidocaine. As it was sufficiently effective to stabilize microvascular anastomosis, continuous brachial plexus blockade was performed for 4 days after the surgery. The color of the finger was stable during this treatment and it was then successfully replanted without infection.
There are several reports of the advantages of brachial plexus blockade; it increases blood flow in replanted digits by preventing neutrally mediated spasms, but pain and agitation may increase the risk of vasospasm. Our case demonstrated its effectiveness at preventing highly damaged tissue due to an animal bite from developing infection and microvascular anastomosis from vasospasm.