A 55-year-old woman, with no known drug allergies or medical or surgical history of interest, diagnosed with rheumatoid arthritis with major involvement of metaphagia in the treatment of dysphalangeal and interphalangeal joints, 50 μ-1.
He came to our hospital due to a poor improvement in pain symptoms, which caused great functional impotence with inability to contract objects and fine hand movements.
Two palmar blocks were performed in each hand, with 10 cc of 0.75% bupivacaine and 40 mg of Depo-trin, with an interval of one week between each.
The patient experienced an overall improvement in pain of 70% and functionality of both hands, allowing her to self-limiting life six months after the last blockade without presenting any side effects or complications deriving from the technique.
The technique is performed under aseptic conditions with a companion that keeps the fingers slightly hyperextended, in order to tense the palm fascia.
We located the puncture site at 3 cm from the cut-off point of an imaginary line directed from the 3rd finger of the hand to the wrist and its flexion line.
We previously performed a subcutaneous injection of 2% lidocaine and then injected with an iv needle, approximately 1 cm deep, 7 cc of 0.75% bupuvacaine +C or declined 40 mg.
For the exact location of the apex locate, continuous pressure is maintained over the syringe, noting an increase in resistance to the palm fascia and a loss of the same injection site prior to the aspiration,
Due to the fact that subcutaneous heel is very painful, as an alternative we can perform iontophoresis with lidocaine prior to the ineffective puncture site.
