United Brachial Plexus Network

Hi,

Anyone here who has done a nerve graph and nerve transfer still suffering from pain?

My had done a nerve graph and nerve transfer sometime in Oct 2003 (avulsed all 5). Todate he is still having excruciating pain on his BPI.

I am wondering at what stage would the pain subside? Anyone here had nerve graph / transfer regain some movement or sensation on the BPI hand?

Have a nice day. Take-care & all the best.


Cheers,
Hwee Yong

Hi JGJ,

Thanks for sharing your view. How long has it been since your nerve graft and nerve transfer? I too am praying very hard that the pain will go away soon. It is a torture to have to endure the pain and my heart ache when I see my dad trying his best to cope with the pain.

It is almost a year now and my dad can only move his shoulder and have sensation on his upper hand, third figure and wrist. I am wondering how long we have to wait to see more improvement so that the pain will subside eventually.

I wish you all the best.


Cheers,
Hwee Yong

REGIONAL ANESTHESIA
Pain Relief After Arthroscopic Shoulder Surgery: A Comparison of Intraarticular Analgesia, Suprascapular Nerve Block, and Interscalene Brachial Plexus Block
François J. Singelyn, MD PhD*, Laurence Lhotel, MD*, and Bertrand Fabre, MD
*Department of Anesthesiology, Université Catholique de Louvain School of Medicine, St. Luc Hospital, Brussels, Belgium; and Department of Anesthesiology, Clinique St. Léonard, Angers, France

Address correspondence and reprint requests to François J. Singelyn, MD, PhD, Department of Anesthesiology, St. Luc Hospital, Avenue Hippocrate 10/1821, B 1200 Brussels, Belgium. Address e-mail to Singelyn@anes.ucl.ac.be.

In this prospective, randomized, blinded study, we assessed the analgesic efficacy of interscalene brachial plexus block (ISB), suprascapular nerve block (SSB), and intraarticular local anesthetic (IA) after arthroscopic acromioplasty. One-hundred-twenty patients were divided into 4 groups of 30. In Group SSB, the block was performed with 10 mL of 0.25% bupivacaine. In Group IA, 20 mL of 0.25% bupivacaine was administered intraarticularly at the end of surgery. In Group ISB, the block was performed with 20 mL of 0.25% bupivacaine. A control group was included for comparison. General anesthesia was administered to all patients. Patients were observed during the first 24 h. Pain scores, supplemental analgesia, satisfaction scores, and side effects were recorded at 4 and 24 h. No significant difference was observed between the IA and control groups. When compared with these groups, Groups SSB and ISB had significantly lower pain scores. At 4-h follow-up, better pain relief on movement was noted in Group ISB than in Group SSB. When compared with controls, a significant reduction in morphine consumption and a better satisfaction score were noted only in Group ISB. We conclude that ISB is the most efficient analgesic technique after arthroscopic acromioplasty. SSN block would be a clinically appropriate alternative.

IMPLICATIONS: The authors demonstrate that single-dose interscalene brachial plexus block is the most efficient analgesic technique after arthroscopic shoulder surgery. A suprascapular nerve block is a clinically appropriate alternative, but single-dose intraarticular local anesthetic has no beneficial effect.
Paul

Hwee,

I agree it seems like a long time since your father's surgery for him to still have the same level of pain. Given that he avulsed all five nerves, how many muscles were targeted for reinnervation during the surgery in October? Of those, how many are showing signs (either outwardly or via an EMG) of nerve activity at this time?

Do you know the distance the grafted & transferred nerves would have to grow to reach the muscles? That could indicate how close your father is to getting more response, which might make a difference in the pain.

Otherwise, is he able to stay distracted & busy? Do you feel comfortable with his pain doctor? It took some time & two different doctors to finally get John to a combination & dosage of three medications, before he had relief. You need a pain doctor with a lot of experience since to a great extent this is a process of trial & error.

We really hurt (figuratively & literally) for your family. It's so, so hard to see a loved one in pain.

Take care & keep us posted.

Ellen