Anesthesia for collagenase clostridium histolyticum injection in patients with dupuytren disease: A cohort analysis.

Publication date: Available online 12 April 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Rafael Sanjuan-Cerveró, Francisco J. Carrera-Hueso, Pedro Vazquez-Ferreiro, Clayton A. Peimer
Procedural pain is one of the most common adverse effects reported by patients with Dupuytren disease treated with collagenase clostridium histolyticum (CCH). The aim of this study was to assess the effectiveness of wrist block prior to CCH injection in reducing procedural pain and analyze its impact on adverse effects. We performed a prospective, single-centre study in which we compared two groups of patients in a consecutive cohort. In the first group (NO-BLOCK), wrist block was only performed before finger extension, while in the second group (BLOCK) it was performed before CCH injection and finger extension. Pain was assessed on a 10-item numerical rating scale. Our results show that pain scores were clearly lower in the BLOCK group than in the NO-BLOCK group: 4.72 vs 0.61 for CCH injection and 3.43 vs 0.82 for finger extension. Patients who rated CCH injection pain with a score of 4 or higher were 11 times more likely to experience pain during extension. There was a weak correlation between the use of wrist block for CCH injection and the occurrence of skin lacerations (Spearman's rho = -0.222, p < 0.01) and the presence of pruritus (Spearman's rho = 0.183, p < 0.07). In conclusion, wrist block prior to CCH injection is an effective measure of decreasing perceived pain throughout the different stages of CCH treatment in patients with Dupuytren disease.