The application of nerve block in early post-operative rehabilitation after tenolysis of the flexor tendon.

Background. Satisfactory outcome after flexor and extensor tenolysis depends on post-operative hand rehabilitation, but the accompanying pain presents a serious obstacle. The aim of our paper was to evaluate the effectiveness of a specific blockade of the distal segments of the median or ulnar nerve in post-tenolysis rehabilitation. Material and methods. During the period 2002-2004 we operated 11 patients (mean age 31, range 17-44) with tenolysis of the flexor tendon (19 tendons). During surgery an epidural catheter was placed in the wrist proximal to an ulnar or median nerve. Bupivacaine was applied through the catheter 3-4 times daily to anesthetize a specific region of the hand. The day after surgery the patients started hand rehabilitation. The active range of motion (ARM) was measured: 1) before surgery, 2) after tenolysis but before bupivacaine, 3) after nerve blockade, 4) ca. 12 weeks after surgery. Pain during exercises before and after the application of bupivacaine was evaluated using a 10-point visual pain scale (VAS). Results. The catheters were removed 5-8 days after surgery (earlier in one case due to inflammation). Apart from 2 ruptured tendons (10.5%) no other complications were observed. The experimental technique produced a 3-point reduction on the VAS. The average increase in ARM after application of the anesthetic was 17.2 degrees . Surgery resulted in an increase in ARM to 74.5 degrees , an average of 73% when measured ca. 12 weeks after surgery. Conclusion. The method of selective post-operative nerve blockade enables more effective hand rehabilitation after tenolysis of the flexor tendon.