Thesis (M.Sc)-Cairo University, 2025.

Bibliography: pages 84-90.

Back ground: The increasing rate of finger surgeries, necessitates the use of the
wide-awake approach to cope with higher flow of patients, posing a challenge on hand
surgeons to choose the most appropriate DNB with highest efficacy & least
complication for different types of finger surgeries.
Objective: to assess efficacy and pain associated with the subcutaneous DNB for
different types of finger surgeries.
Patients & Methods: A group of 51 participants age range (16-65 years), with finger
lesions, recruited from the ER and outpatient setting. All had their operations done
under a single injection SCB injected at midline of the proximal digital crease, with
SC infiltration of 3-5 ml of o.5% bupivacaine. Testing for success was done by
pinprick testing at 5 min intervals and NRS score was used for measuring injection
and procedure pain scores, while surgeon satisfaction was measured on a 1 to 10
scale.
Results: Among the 51 participants undergoing the SCB we had an 86.3% success
rate. Mean injection pain of 3.17±1.7, mean procedure pain 0.84 1.5. The mean TTOA
was 11.3±4.02 minutes, while mean DOP was 20.08±8.6 minutes. Location of the
lesion had a significant impact on failure rate, PP, moderate SS and injection pain, the
former 3 were highest among proximal dorsal regions, while the latter was highest
among proximal volar ones. Ring fingers had higher injection pain while thumb and
little finger had higher failure rate. Higher volume of anaesthetic was associated with
lower procedure pain and shorter TTOA. Success rate was higher among chronic
lesions but results were insignificant. Bony lesions although having a relatively low
injection pain, they had high failure rate and PP level with low level of satisfaction
whereas skin lesions had 100% success rate but the lowest level of surgeon
satisfaction.
Conclusion: The SCB is a safe, efficient DNB, that should be practically integrated
into the everyday practice of hand surgeons, replacing traditional blocks. Surgeons
should apply fine adjustments in block administration on a case-to-case basis
according to modifiable risk factors identified to ensure maximal efficacy and least
pain associated with the block

ﻳﺘﻄﻠﺐ ﺗﺰﺍﻳﺪ ﻣﻌﺪﻝ ﺟﺮﺍﺣﺎﺕ ﺍﻷﺻﺎﺑﻊ ﺍﺳﺘﺨﺪﺍﻡ ﻧﻬﺞ ﺍﻟﻴﻘﻈﺔ ﺍﻟﺘﺎﻣﺔ ﻟﻠﺘﻌﺎﻣﻞ ﻣﻊ ﻋﺪﺩ ﺃﻛﺒﺮ ﻣﻦ
ﺍﻟﻤﺮﺿﻰ، ﻣﻤﺎﻳُﺸﻜﻞ ﺗﺤﺪﻳًﺎ ﻟﺠﺮﺍﺣﻲ ﺍﻟﻴﺪ ﻓﻲ ﺍﺧﺘﻴﺎﺭ ﺃﻧﺴﺐ ﻁﺮﻳﻘﺔ ﻟﺘﺨﺪﻳﺮ ﺍﻟﻌﺼﺐ ﺍﻻﺻﺒﻌﻰ ﺫﺍﺕ
ﺍﻟﻔﻌﺎﻟﻴﺔ ﺍﻟﻌﺎﻟﻴﺔ ﻭﺍﻷﻗﻞ ﻣﻀﺎﻋﻔﺎﺕ ﻟﻤﺨﺘﻠﻒ ﺃﻧﻮﺍﻉ ﺟﺮﺍﺣﺎﺕ ﺍﻷﺻﺎﺑﻊ.
ﻣﺠﻤﻮﻋﺔ ﻣﻦ 51 ﻣﺸﺎ ﺎ ﺗﺘﺮﺍﻭﺡ ﺃﻋﻤﺎﺭﻫﻢ ﺑﻴﻦ

ً

ﺭﻛ 16 ﻭ65 ﺎ، ﻳﻌﺎﻧﻮﻥ ﻣﻦ ﺇﺻﺎﺑﺎﺕ ﻓﻲ ﺍﻷﺻﺎﺑﻊ،

ً

ﻋﺎﻣ
ﺗﻢ ﺗﺠﻨﻴﺪﻫﻢ ﻣﻦ ﻗﺴﻢ ﺍﻟﻄﻮﺍﺭﺉ ﻭﺍﻟﻌﻴﺎﺩﺍﺕ ﺍﻟﺨﺎﺭﺟﻴﺔ.ﺃُﺟﺮﻳﺖ ﻋﻤﻠﻴﺎﺗﻬﻢ ﺟﻤﻴﻌًﺎ ﺑﺎﺳﺘﺨﺪﺍﻡ ﺣﻘﻨﺔ ﻭﺍﺣﺪﺓ
ﻣﻦ ﺗﺨﺪﻳﺮ ﺍﻟﻌﺼﺐ ﺍﻻﺻﺒﻌﻰ ﻋﻦ ﻁﺮﻳﻖ ﺍﻟﺤﻘﻦ ﺗﺤﺖ ﺍﻟﺠﻠﺪ ﻓﻲ ﻣﻨﺘﺼﻒ ﺛﻨﻴﺔ ﺍﻹﺻﺒﻊ ﺍﻟﻘﺮﻳﺒﺔ، ﻣﻊ
ﺣﻘﻦ 3-5 ﻣﻞ ﻣﻦ ﺑﻮﺑﻴﻔﺎﻛﻴﻦ ﺑﺘﺮﻛﻴﺰ 0.5%. ﺗﻢ ﺍﺧﺘﺒﺎﺭ ﺍﻟﻨﺠﺎﺡ ﻋﻦ ﻁﺮﻳﻖ ﺍﺧﺘﺒﺎﺭ ﻭﺧﺰ ﺍﻹﺑﺮﺓ
ﻟﻘﻴﺎﺱ ﺩﺭﺟﺎﺕ ﺃﻟﻢ ﺍﻟﺤﻘﻦ ﻭﺍﻹﺟﺮﺍء NRSﺑﻔﺎﺻﻞ 5 ﺩﻗﺎﺋﻖ، ﻭﺍﺳﺘُﺨﺪﻡ ﺍﻟﻤﻘﻴﺎﺱ ﺍﻟﺮﻗﻤﻰ ﻟﻸﻟﻢ
ﺍﻟﺠﺮﺍﺣﻰ، ﺑﻴﻨﻤﺎ ﺗﻢ ﻗﻴﺎﺱ ﺭﺿﺎ ﺍﻟﺠﺮﺍﺡ ﻋﻠﻰ ﻣﻘﻴﺎﺱ ﻣﻦ 1 ﺇﻟﻰ 10.
ﻣﻦ ﺑﻴﻦ 51 ﻣﺸﺎﺭًﻛﺎ ﺧﻀﻌﻮﺍ ﻟﻌﻤﻠﻴﺔ ﺗﺨﺪﻳﺮ ﺍﻻﺻﺒﻊ ﺑﺤﻘﻨﺔ ﻭﺍﺣﺪﺓ ﺗﺤﺖ ﺍﻟﺠﻠﺪ، ﻛﺎﻥ ﻣﻌﺪﻝ ﺍﻟﻨﺠﺎﺡ
. ﻛﺎﻥ ﻣﺘﻮﺳﻂ ﻭﻗﺖ 1.5±0.84، ﻣﺘﻮﺳﻂ ﺃﻟﻢ ﺍﻹﺟﺮﺍء1.7±86.33.17%. ﻣﺘﻮﺳﻂ ﺍﻟﻢ ﺍﻟﺤﻘﻦ
ﺩﻗﻴﻘﺔ.8.6±20.08ﺩﻗﻴﻘﺔ، ﺑﻴﻨﻤﺎ ﻛﺎﻥ ﻣﺘﻮﺳﻂ ﻭﻗﺖ ﺍﻟﺤﻘﻦ 4.02±11.3ﺍﻟﺤﻘﻦ
ﻛﺎﻥ ﻟﻤﻮﻗﻊ ﺍﻻﺻﺎﺑﺔ ﺗﺄﺛﻴﺮ ﻛﺒﻴﺮ ﻋﻠﻰ ﻣﻌﺪﻝ ﺍﻟﻔﺸﻞ، ﻭﺍﻻﻟﻢ ﺍﻟﺠﺮﺍﺣﻰ، ﻭ ﺭﺿﺎ ﺍﻟﺠﺮﺍﺡ ﺍﻟﻤﻌﺘﺪﻝ،
ﻭﺃﻟﻢ ﺍﻟﺤﻘﻦ. ﻛﺎﻧﺖ ﺍﻟﺜﻼﺛﺔ ﺍﻷﻭﻟﻰ ﻫﻲ ﺍﻷﻋﻠﻰ ﺑﻴﻦ ﺍﻟﻤﻨﺎﻁﻖ ﺍﻟﻈﻬﺮﻳﺔ ﺍﻟﻘﺮﻳﺒﺔ، ﺑﻴﻨﻤﺎ ﻛﺎﻧﺖ ﺍﻷﺧﻴﺮﺓ
ﺍﻷﻋﻠﻰ ﺑﻴﻦ ﺍﻟﻤﻨﺎﻁﻖ ﺍﻟﺮﺍﺣﻴﺔ ﺍﻟﻘﺮﻳﺒﺔ. ﻛﺎﻥ ﺃﻟﻢ ﺍﻟﺤﻘﻦ ﺃﻋﻠﻰ ﻓﻲ ﺍﻟﺒﻨﺼﺮ، ﺑﻴﻨﻤﺎ ﻛﺎﻥ ﻣﻌﺪﻝ ﺍﻟﻔﺸﻞ
ﺃﻋﻠﻰ ﻓﻲ ﺍﻹﺑﻬﺎﻡ ﻭﺍﻟﺨﻨﺼﺮ. ﺍﺭﺗﺒﻂ ﺣﺠﻢ ﺍﻟﺘﺨﺪﻳﺮ ﺍﻷﻛﺒﺮ ﺑﺄﻟﻢ ﺃﻗﻞ ﻓﻲ ﺍﻹﺟﺮﺍء ﻭﻭﻗﺖ ﻟﺘﺤﻘﻴﻖ
ﺍﻟﺘﺨﺪﻳﺮ ﺃﻗﺼﺮ. ﻛﺎﻥ ﻣﻌﺪﻝ ﺍﻟﻨﺠﺎﺡ ﺃﻋﻠﻰ ﺑﻴﻦ ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﻐﻴﺮ ﻁﺎﺭﺋﺔ، ﻟﻜﻦ ﺍﻟﻨﺘﺎﺋﺞ ﻛﺎﻧﺖ ﺿﺌﻴﻠﺔ.
ﺎ ﻣﻨﺨﻔًﻀﺎ ﻧﺴﺒﻴًﺎ ﻋﻨﺪ ﺍﻟﺤﻘﻦ، ﺇﻻ ﺃﻥ ﻣﻌﺪﻝ ﻓﺸﻠﻬﺎ
ﻋﻠﻰ ﺍﻟﺮﻏﻢ ﻣﻦ ﺃﻥ ﺍﻹﺻﺎﺑﺎﺕ ﺍﻟﻌﻈﻤﻴﺔﺗُﺴﺒﺐ ﺃﻟﻤ
ﻭﻣﺴﺘﻮﻯ ﺍﻻﻟﻢ ﺍﻟﺠﺮﺍﺣﻰ ﻓﻴﻬﺎ ﻣﺮﺗﻔﻌﺎﻥ، ﻣﻊ ﺍﻧﺨﻔﺎﺽ ﻣﺴﺘﻮﻯ ﺍﻟﺮﺿﺎ، ﺑﻴﻨﻤﺎ ﺣﻘﻘﺖ ﺍﻹﺻﺎﺑﺎﺕ
ﺍﻟﺠﻠﺪﻳﺔ ﻣﻌﺪﻝ ﻧﺠﺎﺡ 100%، ﻟﻜﻦ ﻣﺴﺘﻮﻯ ﺭﺿﺎ ﺍﻟﺠﺮﺍﺡ ﻛﺎﻥ ﺍﻷﻗﻞ.
ﻳُﻌﺪّ ﺣﻘﻦ ﺍﻟﻤﺨﺪﺭ ﺍﻟﻤﻮﺿﻌﻰ ﻟﺘﺨﺪﻳﺮ ﺍﻟﻌﺼﺐ ﺍﻻﺻﺒﻌﻰ ﺗﺤﺖ ﺍﻟﺠﻠﺪ ﺣﻘﻨًﺎ ﺟﺮﺍﺣﻴًﺎ ﺁﻣﻨًﺎ ﻭﻓﻌﺎﻻ
ﻭﻳﻨﺒﻐﻲ ﺩﻣﺠﻪ ﻋﻤﻠﻴًﺎ ﻓﻲ ﺍﻟﻤﻤﺎﺭﺳﺔ ﺍﻟﻌﻤﻠﻴﺔ ﻟﺠﺮﺍﺣﻲ ﺍﻟﻴﺪ، ﻟﻴﺤﻞ ﻣﺤﻞ ﺍﻟﺘﺨﺪﻳﺮ ﺍﻟﺘﻘﻠﻴﺪﻱ. ﻳﺠﺐ ﻋﻠﻰ
ﺍﻟﺠﺮﺍﺣﻴﻦ ﺇﺟﺮﺍء ﺗﻌﺪﻳﻼﺕ ﺩﻗﻴﻘﺔ ﻓﻲ ﺇﻋﻄﺎء ﺍﻟﺘﺨﺪﻳﺮ ﻋﻠﻰ ﺃﺳﺎﺱ ﻛﻞ ﺣﺎﻟﺔ ﻋﻠﻰ ﺣﺪﺓ، ﻭﻓﻘًﺎ ﻟﻌﻮﺍﻣﻞ
ﺍﻟﺨﻄﺮ ﺍﻟﻘﺎﺑﻠﺔ ﻟﻠﺘﻌﺪﻳﻞ ﺍﻟﺘﻲ ﺗﻢ ﺗﺤﺪﻳﺪﻫﺎ، ﻟﻀﻤﺎﻥ ﺃﻗﺼﻰ ﻗﺪﺭ ﻣﻦ ﺍﻟﻔﻌﺎﻟﻴﺔ ﻭﺃﻗﻞ ﻗﺪﺭ ﻣﻦ ﺍﻷﻟﻢ
ﺍﻟﻤﺼﺎﺣﺐ ﻟﻠﺘﺨﺪﻳﺮ.

Issues also as CD.

Text in English and abstract in Arabic & English.