The role of continuous
bupivacaine infusion either into the
wound or as a local
nerve block, following hand surgery was investigated in 100 patients. After excluding six patients with complex
pain problems in whom neither the
bupivacaine infusion nor any other conventional
analgesic techniques provided adequate
analgesia post-operatively, 86 of 94 (91%) patients were adequately treated for
post-operative pain by this system during the first night after surgery when
pain is presumed to be greatest. This system also provided adequate on-going
analgesia for up to 1 week after surgery, controlling
nerve pain and allowing mobilization of tendons after tenolysis. Continuous
bupivacaine infusion is of particular use in these two groups of patients and after major
hand injuries, when considerable
pain can be anticipated.
Pain during the first night was not controlled adequately by the
bupivacaine infusion system in eight of the 94 patients (8%). All eight had a technical failure of the system, which was rectified in six cases to restore adequate
analgesia by the infusion system. Two patients developed
infection at the infusion
cannula insertion site, which occurred only after 1 week and was successfully treated by removal of the
cannula and oral
antibiotics.