Journal of Anaesthesia & Critical Care Case Reports

Vol 8 | Issue 2 | May-August 2022 | Page: 12-15 | Po-Lai Ho, Anyon Chan, Gerund Yik-Nang Cheung

DOI: 10.13107/jaccr.2022.v08i02.200

Author: Po-Lai Ho [1], Anyon Chan [1], Gerund Yik-Nang Cheung [1]

[1] Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital (TMH), 23 Tsing Chung Koon Road, Tuen Mun, New Territories, HKSAR.

Address of Correspondence

Dr. Anyon Chan,
Department of Anaesthesia and Operating Theatre Services, Tuen Mun Hospital (TMH), 23 Tsing Chung Koon Road, Tuen Mun, New Territories, HKSAR.
E-mail: chananyon663@gmail.com

Abstract

Introduction: Regional anaesthesia is an attractive option for orthopaedic surgery as it offers benefits like improved analgesia, reduced opioid consumption and its associated adverse effects, along with decreased time spent in the post-anaesthetic care unit when compared to general anaesthesia. Nevertheless, its benefits are offset by the limited duration of action which may be solved by the use of adjunct.
Case presentation: The authors present a case of a 45-year-old Chinese who was a chronic smoker and suffered from malunion of right thumb and was scheduled for an elective right thumb osteotomy and fusion with bone graft from iliac crest. He received ultrasound guided distal radial and median nerve block with perineural dexamethasone and dexmedetomidine (dex-dex) as postoperative analgesia, which was not yet mentioned in current literature. His postoperative pain was well controlled, as he reported subjective numbness over territories of the corresponding nerve until 117 hours (approximately five days) after the nerve block. However, the motor block was also prolonged until 45 hours (approximately two days) after regional anaesthesia, and he made full neurological recovery later.
Conclusion: The dex-dex combination proves to be a valuable tool in managing post-operative pain, bearing in mind of the associated prolonged motor block.
Keyword: Dexmedetomidine, Dexamethasone, Nerve block, Analgesia

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