[Axillary plexus catheter block in accidental intra-arterial levomethadone HCl injection in an HIV-positive, hepatitis B and C active drug dependent patient].
We report the case of a 36-year-old male patient who inadvertently injected intraarterially (radial artery) levomethadon-HCl-solution (15 ml corresponding to 37.5 mg) which was intended for substitutional use only. He subsequently developed all clinical signs of malperfusion of his left lower arm and entire hand. Reaching the clinic only two hours after the injection, he received a continuous axillary plexus block which led to the nearly complete restoration of the perfusion of his left lower arm and hand. Thus, we were able to avoid further surgical interventions. We were using the new local anesthetic substance Ropivacain (Naropin), which offers the advantage of 12-hour-injection intervals. Already 36 hours after the "trauma", colour-coded Doppler sonography demonstrated normal flow-rates of the radial, ulnar, and common digital arteries. Only the arterial flow of the index and middle fingers was not detectable at that time--corresponding to partial hypaesthesia of the tip of the second and radial side of the third digits. Even if there are no studies concerning the continuous axillary plexus block in HIV, hepatitis B- and C-positive patients, this anaesthesiological technique should not be withheld from this group of immunocompromised patients.
Abteilung für Anästhesiologie und operative Intensivmedizin, Berufsgenossenschaftliche Unfallklinik Tübingen.
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Ebert
D000328:Adult; D000577:Amides; D000779:Anesthetics, Local; D001132:Arm / Q000098:blood supply*; D001366:Axillary Artery; D001783:Blood Flow Velocity / Q000187:drug effects; D001917:Brachial Plexus / Q000187:drug effects; D002408:Catheters, Indwelling; D006679:HIV Seropositivity / Q000503:physiopathology*; D006509:Hepatitis B / Q000503:physiopathology*; D006526:Hepatitis C / Q000503:physiopathology*; D006556:Heroin Dependence / Q000503:physiopathology* / Q000534:rehabilitation; D006801:Humans; D007269:Injections, Intra-Arterial; D007511:Ischemia / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000506:poisoning*; D009407:Nerve Block; D012039:Regional Blood Flow / Q000187:drug effects; D000077212:Ropivacaine; D015819:Substance Abuse, Intravenous / Q000503:physiopathology*; D018615:Ultrasonography, Doppler, Color / Q000187:drug effects
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D008691:Methadone