Related Experiment Videos
Iatrogenic compartment syndrome from hypertonic saline injection in Bier block
J R Mabee1, T L Bostwick, M K Burke
1Department of Emergency Medicine, Los Angeles County, California.
The Journal of Emergency Medicine
|July 1, 1994
Summary
An accidental injection of hypertonic saline during a Bier's block for a Bennett's fracture caused iatrogenic forearm compartment syndrome. This rare complication highlights the critical need for precision in intravenous regional anesthesia procedures.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Emergency Medicine
Background:
- Intravenous regional anesthesia (Bier's block) is a technique used for limb surgeries.
- Bennett's fracture is a common fracture of the thumb base.
- Compartment syndrome is a painful condition that occurs when pressure within the muscle compartments of the body increases.
Observation:
- A case study details an iatrogenic forearm compartment syndrome in a patient undergoing Bier's block.
- Hypertonic saline (23.4%) was mistakenly used to dilute lidocaine for the anesthesia.
- The patient developed acute compartment syndrome after tourniquet release.
Findings:
- Emergent fasciotomy was necessary to treat the compartment syndrome.
- The pathogenesis may involve vein sclerosis and, more significantly, increased extracellular fluid volume due to osmotic shifts after tourniquet release.
- Meticulous attention to detail is crucial during Bier's block administration.
Implications:
- This case underscores the potential risks of medication errors in anesthesia.
- It emphasizes the importance of understanding fluid dynamics and osmotic principles in iatrogenic complications.
- Highlights the need for enhanced safety protocols in regional anesthesia to prevent severe outcomes like compartment syndrome.