RESUMEN

Upper extremity peripheral nerve injuries present functional deficits that are amenable to management by tendon or nerve transfers. The principles of tendon and nerve transfers are discussed, with technical descriptions of preferred tendon and nerve transfers for radial, median, and ulnar nerve injuries.

Asunto(s)

Transferencia de Nervios , Traumatismos de los Nervios Periféricos , Transferencia Tendinosa , Extremidad Superior , Humanos , Traumatismos de los Nervios Periféricos/cirugía , Transferencia Tendinosa/métodos , Transferencia de Nervios/métodos , Extremidad Superior/inervación , Extremidad Superior/cirugía , Extremidad Superior/lesiones , Nervio Cubital/lesiones , Nervio Cubital/cirugía , Nervio Mediano/lesiones , Nervio Mediano/cirugía , Nervio Radial/lesiones , Nervio Radial/cirugía

RESUMEN

BACKGROUND: Prior studies have investigated the use of vibratory anesthesia for injectional pain reduction in dental, ophthalmologic, and plastic surgery literature. Scarce research has been aimed at determining the effect of vibratory anesthesia on hand and upper extremity injections. It is common practice for surgeons to use vapocoolant spray prior to injection, but there is no strong evidence to support its widespread use. No prior studies have performed a head-to-head analysis of vibratory anesthesia versus vapocoolant spray effect on injectional pain. We hypothesized that both vibratory anesthesia and cold spray anesthesia decrease patient-reported pain of corticosteroid injections compared with injection without anesthesia. METHODS: We performed a randomized, prospective study to compare patient-reported pain of injection when the participants were randomly assigned to 1 of the 3 groups: injection without anesthesia, injection with vapocoolant(cold) spray, and injection with vibratory anesthesia. All participants completed a preinjection survey to assess the expected pain of injection and an identical postinjection survey to assess the actual perceived pain. RESULTS: Sixty injections were performed in each intervention, for a total of 180 injections. We found that both vapocoolant spray and vibratory anesthesia decreased patient-reported injection pain compared with no intervention, but only vibratory anesthesia reached statistical significance. CONCLUSION: Vibratory anesthesia is a useful adjunct for injections of the hand and upper extremity, as has been demonstrated in other specialties' literature. Although our statistical findings on vapocoolant spray are consistent with prior studies, there may still be clinical benefit in its application.