ANAESTHETIC MANAGEMENT OF TRAUMATIC FINGER AMPUTATION: A CASE REPORT

Abstract

Introduction: Traumatic digital amputation is one of the most frequent injuries of the upper extremity and usually requires urgent debridement, stump revision and skeletal stabilisation. The anaesthetic plan in this emergency setting must reconcile surgical urgency, the presumed full stomach of the trauma patient, patient cooperation and the need for effective perioperative analgesia. Although brachial plexus block is frequently advocated for hand surgery, general anaesthesia remains a valid option in selected situations.

Case presentation: A 40-year-old man sustained a motorcycle collision in which his right hand was dragged along the asphalt. He presented fully conscious (Glasgow Coma Scale E4V5M6) and haemodynamically stable (blood pressure 110/60 mmHg, heart rate 62 beats/min, SpO₂ 99%) with traumatic amputation (vulnus amputatum) of the right little finger and open fractures of the middle phalanges of the right middle and ring fingers. Laboratory testing showed leucocytosis (13.52 × 10³/µL) with neutrophilia and a neutrophil-to-lymphocyte ratio of 5.08; haemostasis, renal and hepatic function were normal, and the electrocardiogram showed sinus rhythm. He was classified as ASA physical status I-E.

Management and outcome: Emergency (cito) wound debridement, stump plasty of the fifth digit and open reduction with Kirschner-wire fixation of the third and fourth digits were performed in the supine position under general anaesthesia, chosen because of the urgency of the procedure, the limited cooperation of the patient and the need for optimal immobility and airway control. Anaesthesia lasted 60 minutes and surgery 45 minutes, with minimal blood loss and no anaesthetic or surgical complication. Postoperative care comprised intravenous ceftriaxone, balanced crystalloid infusion, tetanus immunoprophylaxis and multimodal analgesia; on follow-up the wound was clean and dry with good distal neurovascular status.

Conclusion: General anaesthesia is a safe and appropriate technique for emergency finger amputation when regional anaesthesia is impractical, provided that aspiration precautions, adequate anaesthetic depth and an opioid-sparing multimodal analgesic strategy are applied. Regional techniques should be considered as analgesic adjuncts whenever feasible.