The outcome of upper limb tendon transfer surgery is improved when the patient is able to voluntarily contract specific muscles during the surgical procedure. Tumescent local anesthesia is suitable, but we describe an alternative option that involves the novel management of an axillary block. A 47-year-old man, injured in a motor vehicle crash, exhibited a thumb extensor deficit because of severe muscular trauma to the forearm. He underwent a tendon transfer of the fourth superficial flexor tendon to the extensor pollicis longus under an axillary block. First, individual injections of ropivacaine were performed around the musculocutaneous, radial, and ulnar nerves with ultrasound guidance. Second, a perineural catheter was placed near the median nerve and lidocaine injected. Voluntary flexor muscle contraction reappeared in time for the surgeon to adjust his suture tension.
From the *Department of Anesthesiology, Rodez General Hospital, Rodez, France
†Departement of Orthopedic Surgery, Orthopedic Surgery, Rodez General Hospital, Rodez, France.
Accepted for publication November 21, 2018.
The authors declare no conflicts of interest.
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Address correspondence to Thierry Garnaud, MD, Department of Anesthesiology, Rodez General Hospital, Ave de l’Hôpital, 12000 Rodez, France. Address e-mail to email@example.com.