Percutaneous needle fasciotomy

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Also known as ‘Needle aponeurotomy’, this procedure is commonly used to treat Dupuytren’s Contracture. In this procedure the surgeon uses a needle to weaken the contracted cord (Dupuytren’s cord) to allow straightening of the finger and better hand function. The initial success rate of this procedure is between 85-90%. This is an alternative to open surgery, where a larger cut would be made on the skin, increasing the risk of damage to the hand and associated with a longer recovery time. Local anaesthetic is used in PNF to make the procedure completely pain-free. This means that the patient is awake during the procedure and is usually able to return home the same day. This study focuses on the method used to administer the local anaesthetic. Two techniques are available: local block anaesthesia and forearm block anaesthesia.

Local Block

A local block is where the skin directly overlying the tight dupuytren’s cord is injected with local anaesthetic using a needle. This is carried out by the surgeon just before the start of the procedure and is routine for PNF.

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The injection is initially painful, however, within a few minutes the skin should be anaesthetised. This means that although the patient will be able to feel sensations of movement as the procedure is being carried out, there will be no pain. The surgeon will not start the procedure until the area is pain-free.

Risks of this method of anaesthesia include bleeding, pain and a small risk of infection and damage to nearby nerves. There is also the risk of numbing the nerves of the fingers, which may make it difficult for the surgeon to locate these nerves and avoid them during the procedure.

Ultrasound guided Forearm Block

A forearm block is where the nerves that supply the skin and structures of the hand are injected with local anaesthetic in the forearm. The nerves are found using an ultrasound probe, which uses harmless ultrasound waves to find the correct nerve. This reduces the risk of damage to other structures such as blood vessels.

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This procedure would be carried out by an anaesthetist with special training in this technique. While not routinely used for PNF, this procedure is commonly used for other wrist and hand operations. The risks of this procedure are similar to a local block, with bleeding, pain and a small risk of infection and damage to nearby nerves and blood vessels. However, there is no risk of affecting the nerves of the fingers, making it easier for the surgeon to find these nerves and avoid them. Patients have also often suggested that less pain is felt in this procedure, compared to injections directly into the hand.