Continuous Brachial Plexus Blockade Using an Axillary Catheter for Treatment of Accidental Intra-arterial Injections

Abstract

Vascular insufficiency of the upper extremity is a common sequela of accidental intra-arterial injection of various drugs. Treatment usually is directed at controlling vasospasm by stellate ganglion block and/or injections of intra-arterial reserpine or intravenous papaverine, and at decreasing venous thrombosis by infusion of heparin, dextran, or fibrinolysin. The use of continuous brachial plexus block with constant infusion of bupivacaine through a Racz TM catheter to treat vascular insufficiency secondary to intraarterial methylphenidate.HCI injection is described. Advantages of this technique include total pain relief while sustaining a continuous sympathetic blockade without invading the arterial supply. The particular catheter used helps eliminate the fear of migration of the catheter into the axillary artery or vein because of its blunt stainless steel tip. Theories of how intra-arterially injected agents cause vascular insufficiency and the rationale for therapeutic approaches are discussed.