Acidente por injeção medicamentosa no músculo deltoide: lesões locais e à distância, revisão de 32 casos

Abstract

IntroduçãoO advento da seringa de injeção hipodérmica em 1853 (Charles Gabriel Pravaz), logo seguida da fabricação da seringa inteiramente de vidro em 1869 (Georg Wilhelm Amathus Luer), permitiu a administração de medicamentos via parenteral. O novo processo fez sucesso, mas, imediatamente, surgiram as complicações. ARTIGO DE REVISÃO ResumoAnálise de 32 casos de acidentes por injeção, na maioria das vezes, de substâncias oleosas no músculo deltoide. Os acidentes caracterizaram-se por dor e reações tróficas locais. Em muitos casos, simultaneamente, ocorreram distúrbios isquêmicos nas regiões escapular, peitoral e, especialmente, na extremidade do membro. Presume-se que esse complexo lesional é gerado: 1) pela ação lesiva do medicamento nas terminações nervosas, nos tecidos moles e perivasais; e/ou 2) pela entrada fortuita da substância no interior dos vasos, produzindo embolia e/ou endotelite trombosante; e/ou 3) pelo despertar de fenômenos vasomotores.As lesões da mão, geralmente, foram mais graves que as lesões deltoidianas, com a eventual perda de dedos, espontânea ou cirúrgica. Os diversos quadros clínicos do acidente foram semelhantes, mas algumas características lesionais permitiram identificar mecanismos fisiopatogênicos peculiares, o que tem significado conceitual e terapêutico. Palavras-chave:Dermite livedoide, arterite cútis medicamentosa, embolia cútis medicamentosa, síndrome de Nicolau, síndrome de Freudenthal, acidente por injeção intramuscular, gangrena de mão. AbstractAnalysis of 32 cases of accidental injection of oily suspension (in most cases) into the deltoid muscle is reported. Pain and local ulcers characterized the accidents. In many cases, simultaneous ischemic disorders were observed in the scapular and pectoral regions and especially in the end of the upper limb. It is presumed that this complex lesion was caused by 1) the harmful action of the medication on nervous terminations, soft and perivascular tissues; and/or 2) occasional entrance of the substance into blood vessels, causing embolism and/or thrombotic endothelitis; and/or 3) vasomotor phenomena.Hand injuries were generally more severe than injuries in the deltoid region, with occasional spontaneous or surgical loss of fingers. Clinical statuses were similar, though some lesions had features, which allowed identification of peculiar physiopathogenic mechanisms, with conceptual and therapeutic significance.

Post-injection embolia cutis medicamentosa – Nicolau Syndrome: case report and literature review

“…In 1925, Nicolau observed complications of intramuscular injections with mercurial or bismuth salt for syphilis treatment, describing the phenomenon more accurately. 5,[7][8][9] This is a rare reaction involving skin, subcutaneous tissue, and muscle tissue and can be seen as a complication of intramuscular, intra-articular or subcutaneous injections, the last of which is the rarest cause. The incidence of reactions to intramuscular injection varies from 0.4% to 19.3% and the most common types of complications include bleeding at the injection site, hematoma, and sciatic nerve injury.…”

“…Moreover, animal models have confirmed vasospasm reaction caused by injections, leading to tunica intima damage. 7,9,18,[19][20][21] The pharmacological properties of injected drugs can also contribute to onset of NS. For example, the NSAIDs are cyclooxygenase inhibitors, and therefore cause vascular spasm and subsequent restriction of blood circulation, since the enzyme inhibits prostaglandin synthesis.…”

“…Nicolau syndrome can be fatal in children. 3,7,9,13,22 Furthermore, the syndrome can cause neurological complications, such as paraplegia, hypoesthesia, and stereognosis. In 2010, a case of NS was described that progressed to irreversible lesion of a lower limb and vesical sphincter dysfunction, caused by a reduction of blood flow in the inferior gluteal artery, which led to compromised irrigation of the sciatic and pudendal nerves.…”

Las relaciones anatómicas involucradas en la administración de medicamentos por vía intramuscular: un campo de estudio de la enfermera

“…Respecto a la vascularización se presume que la sustancia inyectada en el músculo deltoides penetre fortuitamente en las arterias circunflejas del cuello del húmero, alcance la arteria axilar y de ahí camine para uno de sus ramos, eventualmente condicionado por normales variaciones anatómicas de la red arterial axilar (9) .…”

Efficacy and Safety in Intramuscular Injection Techniques Using Ultrasonographic Data

“…Delivered by intramuscular (IM) injections, Long Acting Injections (LAI), offering comparatively long term medicinal effects from several weeks to several months, are gaining much attention [1] [2] [3] [4]. However, there are dangers such as vascular damage, muscle contracture, nerve injury due to IM injection [5] [6] [7] [8] [9], and injections site reactions such as redness and swelling, which may occur [10] [11]. In particular, oily formulation LAIs, which have been designed so that the drug metabolizes in the muscle, contain aspects warranting careful attention, such as being more irritant than the usual medicines [12], and having a higher viscosity.…”