Ischemic Hand Complications From Intra-Arterial Injection of Sublingual Buprenorphine/Naloxone Among Patients With Opioid Dependency

Abstract

With the increasing use of sublingual buprenorphine/naloxone in opioid dependency, ischemic hand injuries will be seen with greater frequency. Whereas outcomes did not vary with treatment modality in this series, further study is needed to determine the most effective treatment of these injuries.

Wrong-route drug administration errors: A review of the literature

“…[18] Slight elevation of the affected limb allows for an improvement in oedema and contributes to relief of pain. [18,30,35,37] In iatrogenic cases of intraarterial injection, it is recommended to maintain the intra-arterial catheter, rather than remove it, to allow for the direct administration of medications to the site of injury. [18] The most widely recommended aspect of treatment is the initiation of unfractionated heparin to prevent extension of thrombosis.…”

“…An initial loading dose of 5 000 IU heparin, followed by continuous infusion to maintain the partial thromboplastin time two times the control value has been recommended. [18,30,37] Ongoing heparin infusion, until resolution of pain and swelling or angiographic improvement, is advised.…”

“…A wide variety of additional treatment modalities are discussed in case reports, including aspirin, clopidogrel, local anaesthetics, corticosteroids, calcium channel blockers, reserpine, papaverine and prostaglandins. [33,37,38] Aspirin and clopidogrel have been used for their anti-platelet activity. [37] Intra-arterial injection of local anaesthetic to relieve both pain and vasospasm has been reported.…”

“…[33,37,38] Aspirin and clopidogrel have been used for their anti-platelet activity. [37] Intra-arterial injection of local anaesthetic to relieve both pain and vasospasm has been reported. [37] Blockage of sympathetic outflow to the affected limb via stellate ganglion or brachial plexus block produces vasodilation and has been used to relieve pain and improve perfusion.…”

“…[37] Intra-arterial injection of local anaesthetic to relieve both pain and vasospasm has been reported. [37] Blockage of sympathetic outflow to the affected limb via stellate ganglion or brachial plexus block produces vasodilation and has been used to relieve pain and improve perfusion. However, because of the risks associated with this intervention, particularly in the context of concomitant anticoagulation, it is not considered a first-line intervention.…”