Objective      To determine the effect of papaverine thro

ugh topical

intravenous or intramuscular injection combined with bupivacaine for axillary brachial plexus anesthesia on the plasma levels of calcitonin gene-related peptide (CGRP) and endothelin (ET) in patients after replantation of amputated fingers.       Methods      A total of 120 emergency patients with single amputated finger admitted in our hospital from January to December 2014 were randomly divided into 4 groups

groups A

B and C (observation groups) and group D (control group). All patients were given totally 40.2±2.9 mL 0.25% bupivacaine (1.5 mg/kg) for anesthesis in axillary brachial plexus through location of the neural stimulator

and the patients of groups A

B and C were given 0.062 5 mg/mL papaverine at a dose of 0.037 5 mg/kg respectively through added in local anesthetic solution

intravenous drop and intramuscular injection. The peripheral venous blood samples in 4 groups were taken beforeanesthesia (T

0

) and at 0.5 (T

1

)

1 (T

2

)

2 (T

3

)

4 (T

4

)

8 (T

5

) and 12 h (T

6

) after anesthesia. The plasma CGRP and ET concentration were measured by radioimmunoassay. The incidence of vascular crisis and survival rate of replanted finger were recorded after a week.       Results      The plasma concentration of CGRP was higher in group A than group D at T

1

T

2

T

3

T

4

and T

5

while that of ET in group A was lower than group D at the same time points (P0.05). The level of CGRP was higher in group B than group D at T

1

while that of ET was lower in group B than group D at T

1

(P0.05). In the group A

the level of CGRP was higher while that of ET was lower at T

1

T

2

T

3

T

4

and T

5

than at T

0

(P0.05). In the group B

the level of CGRP was higher while that of ET was lower at T

1

than at T

0

(P0.05). There was no vascular crisis and all the amputated fingers survived in the g

roup A

while in the groups B

C and D

there were respectively 2

3 and 6 cases having vascular crisis

and respectively 1

2 and 2 cases having necrotic amputated finger.       Conclusion       Papaverine through local anesthetic solution combined with bupivacaine in axillary brachial plexus anesthesia keeps increasing the plasma level of CGRP and decreasing that of ET compared with treated by other ways within a short time and for quiet a long time

and then reduces vascular crisis and improves the survival rate of replanted finger in patients with amputated fingers.