{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T14:43:03Z","timestamp":1776091383905,"version":"3.50.1"},"reference-count":33,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T00:00:00Z","timestamp":1758153600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shanghai Municipal Health Commission Scientific Research Project","award":["202240154"],"award-info":[{"award-number":["202240154"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Pain-induced vasoconstriction and thrombosis cause vascular insufficiency, a major etiology of early necrosis in replanted digits. While systemic intravenous analgesia (SIVA) carries significant side effects, continuous brachial plexus block (CBPB) provides analgesia with vasodilation. Amidst uncertainties regarding distal vascular recanalization and sympathetic denervation, whether CBPB\u2019s hemodynamic effects translate into improved perfusion and outcomes in replanted digits remains unknown. This randomized controlled trial compared the effects of CBPB versus SIVA on digit perfusion, vascular insufficiency, and survival rates post-replantation. Methods: After screening 113 patients, 55 patients (71 digits) were ultimately randomized and analyzed: the CBPB group (n = 27, 36 digits) received 0.2% ropivacaine infusion at 5 mL\/h; the SIVA group (n = 28, 35 digits) received intravenous parecoxib 20 mg twice daily with supplemental tramadol for visual analog scale (VAS) scores &gt; 3. The primary outcome was digital skin temperature trajectory measured at 0, 12, 24, 36, and 48 h postoperatively. Secondary outcomes included Doppler-quantified combined volumetric flow rate of the radial and ulnar arteries (RA-UA VFR) at identical timepoints, VAS scores, vascular insufficiency incidence, and 7-day digit survival. Results: CBPB significantly enhanced perfusion in replanted digits at all postoperative timepoints, with digital skin temperature peaking at 48 h (32 \u00b1 1.6 \u00b0C vs. 31 \u00b1 1.1 \u00b0C; p &lt; 0.001) and RA-UA VFR peaking at 24 h (4.0 \u00b1 0.83 vs. 1.8 \u00b1 0.51 mL\/s; p &lt; 0.001) versus SIVA. Concurrently, CBPB provided superior analgesia (VAS 0.52 \u00b1 0.51 vs. 1.9 \u00b1 1.0; p &lt; 0.001) and significantly reduced 48-h vascular insufficiency incidence (8.3% vs. 29%; p = 0.028). No significant difference was observed in seven-day survival rates between groups (97% vs. 91%; p = 0.329). Conclusions: CBPB significantly enhanced perfusion in replanted digits and reduced the incidence of vascular insufficiency, despite not conferring additional survival benefits.<\/jats:p>","DOI":"10.3390\/jcm14186591","type":"journal-article","created":{"date-parts":[[2025,9,18]],"date-time":"2025-09-18T14:45:46Z","timestamp":1758206746000},"page":"6591","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Perfusion Enhancement via Continuous Brachial Plexus Block to Prevent Vascular Insufficiency in Replanted Digits: A Prospective, Randomized Controlled Trial"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6479-0513","authenticated-orcid":false,"given":"Yang","family":"Xu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-7803","authenticated-orcid":false,"given":"Fang","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6752-1131","authenticated-orcid":false,"given":"Yan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shenghe","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5868-4079","authenticated-orcid":false,"given":"Tao","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 600 Yishan Road, Shanghai 200233, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2127","DOI":"10.2106\/JBJS.L.01219","article-title":"Digit replantation: Experience of two U.S. academic level-I trauma centers","volume":"95","author":"Fufa","year":"2013","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_2","first-page":"1","article-title":"The success of salvage procedures for failing digital replants: A retrospective cohort study","volume":"38","author":"Hatchell","year":"2018","journal-title":"Microsurgery"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1016\/j.jhsa.2008.05.005","article-title":"Reconstruction of circulation in the fingertip without vein repair in zone I replantation","volume":"33","author":"Zhang","year":"2008","journal-title":"J. Hand Surg. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e732","DOI":"10.5435\/JAAOS-D-20-01176","article-title":"Postoperative digit and hand replantation protocols: A review of the literature","volume":"29","author":"Chen","year":"2021","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1056\/NEJMra025411","article-title":"Opioid therapy for chronic pain","volume":"349","author":"Ballantyne","year":"2003","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1016\/j.rapm.2005.07.110","article-title":"Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers","volume":"30","author":"Kurt","year":"2005","journal-title":"Reg. Anesth. Pain. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1097\/AAP.0b013e318234007e","article-title":"Regional hemodynamic changes after an axillary brachial plexus block: A pulsed-wave Doppler ultrasound study","volume":"37","author":"Li","year":"2012","journal-title":"Reg. Anesth. Pain. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1159\/000475813","article-title":"Skin perfusion changes within 12 h after axillary plexus block","volume":"58","author":"Wenger","year":"2017","journal-title":"Eur. Surg. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2050313X18823094","DOI":"10.1177\/2050313X18823094","article-title":"Prolonged continuous infraclavicular brachial plexus perineural infusion following replantation of a mid-humeral amputation","volume":"7","author":"Clifford","year":"2019","journal-title":"SAGE Open Med. Case Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1213\/XAA.0000000000000728","article-title":"Regional anesthesia in the setting of arm replantation: A case report","volume":"11","author":"Stevens","year":"2018","journal-title":"A A Pract."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1097\/CORR.0000000000002578","article-title":"Is Prolonged Use of Antibiotic Prophylaxis and Postoperative Antithrombotic and Antispasmodic Treatments Necessary After Digit Replantation or Revascularization?","volume":"481","author":"Chen","year":"2023","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_12","unstructured":"Standring, S. (2020). Gray\u2019s Anatomy: The Anatomical Basis of Clinical Practice, Elsevier. [42nd ed.]."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Xu, Y., Cui, D., Zhang, J., Ding, Q., Dong, J., and Wang, Y. (2021). Blood flow changes in the forearm arteries after ultrasound-guided costoclavicular brachial plexus blocks: A prospective observational study. BMC Anesthesiol., 21.","DOI":"10.1186\/s12871-021-01383-w"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bosselmann, T., Kolbenschlag, J., Goertz, O., Daigeler, A., Behr, B., and Kapalschinski, N. (2021). Improvement of superficial and deep cutaneous microcirculation due to axillary plexus anesthesia impaired by smoking. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102114"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1038\/327524a0","article-title":"Nitric oxide release accounts for the biological activity of endothelium-derived relaxing factor","volume":"327","author":"Palmer","year":"1987","journal-title":"Nature"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Li, Y., Dieussaert, E., and Baets, R. (2022). Miniaturization of laser Doppler vibrometers\u2014A review. Sensors, 22.","DOI":"10.3390\/s22134735"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.infrared.2012.03.007","article-title":"Medical applications of infrared thermography: A review","volume":"55","author":"Lahiri","year":"2012","journal-title":"Infrared Phys. Technol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1016\/j.jhsa.2010.12.023","article-title":"Replantation of finger avulsion injuries: A systematic review of survival and functional outcomes","volume":"36","author":"Sears","year":"2011","journal-title":"J. Hand Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1056\/NEJMra0801082","article-title":"Mechanisms of thrombus formation","volume":"359","author":"Furie","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0363-5023(78)80133-6","article-title":"Pharmacological alterations in the clotting mechanism: Use in microvascular surgery","volume":"3","author":"Ketchum","year":"1978","journal-title":"J. Hand Surg. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1056\/NEJM199709043371007","article-title":"Low-molecular-weight heparins","volume":"337","author":"Weitz","year":"1997","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1002\/micr.10077","article-title":"Dextrans in microsurgery: A review","volume":"23","author":"Jallali","year":"2003","journal-title":"Microsurgery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1038\/nm.1955","article-title":"A shear gradient-dependent platelet aggregation mechanism drives thrombus formation","volume":"15","author":"Nesbitt","year":"2009","journal-title":"Nat. Med."},{"key":"ref_24","first-page":"834","article-title":"The interplay between shear stress and \u03b1-adrenergic signaling in endothelial von Willebrand factor release","volume":"16","author":"Bierings","year":"2018","journal-title":"J. Thromb. Haemost."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"265","DOI":"10.4103\/0019-5413.156185","article-title":"Nonsurgical factors of digital replantation and survival rate: A meta-analysis","volume":"49","author":"Yu","year":"2015","journal-title":"Indian J. Orthop."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1142\/S0218810413500342","article-title":"Continuous infraclavicular brachial plexus blockade: Effect on survival of replanted digits","volume":"18","author":"Niazi","year":"2013","journal-title":"Hand Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/S0304-3959(01)00349-9","article-title":"Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale","volume":"94","author":"Farrar","year":"2001","journal-title":"Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1093\/bja\/aew466","article-title":"Measuring acute postoperative pain using the visual analog scale: The minimal clinically important difference and patient acceptable symptom state","volume":"118","author":"Myles","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"97","DOI":"10.4097\/kja.21227","article-title":"Distance of catheter tip dislocation in continuous interscalene brachial plexus block","volume":"75","author":"Abe","year":"2022","journal-title":"Korean J. Anesthesiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1136\/rapm-2020-101585","article-title":"Evaluating the spread of costoclavicular brachial plexus block: An anatomical study","volume":"46","author":"Koyyalamudi","year":"2021","journal-title":"Reg. Anesth. Pain. Med."},{"key":"ref_31","first-page":"CD009894","article-title":"Low molecular weight heparin for prevention of microvascular occlusion in digital replantation","volume":"4","author":"Lin","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1055\/s-0038-1626689","article-title":"Predictors of digit survival following replantation: Quantitative review and meta-analysis","volume":"10","author":"Shaterian","year":"2018","journal-title":"J. Hand Microsurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1097\/PRS.0000000000002600","article-title":"The effect of smoking on necrosis rate in digital replantation and revascularization with prostaglandin E1 therapy: A retrospective study","volume":"138","author":"Nishijima","year":"2016","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6591\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:48:31Z","timestamp":1760035711000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/18\/6591"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,18]]},"references-count":33,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2025,9]]}},"alternative-id":["jcm14186591"],"URL":"https:\/\/doi.org\/10.3390\/jcm14186591","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,18]]}}}