TY - BOOK AU - Ahmed Naser Hanafi Mahmoud, AU - Yasser ElSafoury AU - Mostafa Ezzat AU - Mohamed Ahmed Mohamed Ibrahim TI - Is single-injection digital nerve block technique effective in finger surgeries done under local anaesthesia? U1 - 616.723 PY - 2025/// KW - Orthopedics KW - طب العظام KW - Finger KW - Digital nerve block KW - Single injection KW - Subcutaneous KW - تقنية التخدير للعصب الإصبعى بحَقنة واحدة فعالة KW - تحت التخدير الموضعى N1 - Thesis (M.Sc)-Cairo University, 2025; Bibliography: pages 84-90; Issues also as CD N2 - 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 ER -