ESRA Academy. Peris R. Sep 8, 2016; 138487; 0346 Topic: PAIN THERAPY (ACUTE - CHRONIC)
Mrs. Raquel Peris
Mrs. Raquel Peris

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Background and Aims:

Rheumatoid arthritis associates severe stiffness and pain in several joints. Total elbow or wrist replacement may be indicated in these patients as the last therapeutic option. Little is written about pain management in these patients highlighting the importance of a prompt rehabilitation and the severe pain. We present 2 cases and our pain management.  


Case 1: Total elbow replacement surgery using a supraclavicular ultrasound (US) guided blockade + catheter as pain management technique.

Case 2: Total wrist replacement surgery using an infraclavicular US guided blockade + catheter as pain management technique.

The catheters were continuously used during the following 48hs (levobupivacain 0.125% 5 ml/h) with patient controlled analgesia option (PCA).


US-guided blockade + catheter infusion + PCA enabled a prompt painless active and passive rehabilitation without motor blockade. No opioid consumption was needed, only dexketoprofen was administered. No incidences were reported.

EVA scale was performed twice a day in repose and movement during the catheter infusion + PCA, being the punctuation in all cases 3 or less.


US-guided brachial plexus block in patients undergoing upper extremity arthroplasty reduces perioperative opioid consumption and wound pain in the early postoperative period. In addition, a local anesthetic infusion through the catheter + PCA associated could be the key for an early and painless rehabilitation.

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