Motor-sparing continuous median nerve block for hand surgery: A pediatric case

Here is described a successful perioperative pain control with continuous median nerve block after flexor tendon repair surgery on 2nd finger of a child. A 9-year-old patient was admitted for reconstruction surgery. The combination of median nerve block and lateral/medial antecubital cutaneous nerve blocks were performed before the surgery to cover all the surgical incision including the 2nd finger, palm, the graft site proximal to the wrist, and Kleinert traction at the nail bed. At the end of the surgery, the infusion catheter was inserted at the distal one-third to spare the muscle strength of flexor digitorum muscles. Continuous bupivacaine infusion provided complete analgesia until the postoperative day 4 without interfering the postoperative physiotherapy. The continuous median nerve block at the distal one-third of the forearm spared finger flexion, and supported effective postoperative early mobilization after zone 2 flexor tendon repair surgery.