Compartment Syndrome of the Hand Induced by Peripherally Extravasated Phenylephrine

Abstract

Background: Compartment syndrome of the hand is a rare and devastating complication of peripheral intravenous extravasation. With changes in critical care research, vasoactive medications are now more frequently administered through peripheral lines in the acute setting. Methods: We present the case of a patient diagnosed with compartment syndrome of the hand secondary to phenylephrine extravasation in the setting of hypovolemic shock. Results: The use of fasciotomy compartment release and intraoperative phentolamine resulted in significant improvement in tissue perfusion postoperatively. Conclusion: With incraesed incidence of peripherally administered vasoactive medications, the hand surgeon should be aware of potential complications and treatment of compartment syndrome with urgent fasciotomy and phentolamine administration.

Fluid vs. Phenylephrine: Compartment Syndrome in the Hand Following Massive Volume Resuscitation

“…3 Taken together, it is very plausible that the IV catheter may have been passively “pulled” out of the vein by expanding subcutaneous tissues of the hand at some point during the substantial fluid resuscitation, subsequent emergency laparotomy, and critical care sequence. Indeed, at the time of fasciotomy, hand muscles were noted to be “tense and edematous” with “significant fluid in the subcutaneous tissues.” 1 Theses findings are more in keeping with a dislodged IV catheter through which fluids were subcutaneously administered than vasoconstrictor-mediated injury.…”

“…We thank the authors for the report on compartment syndrome in the hand of a patient following phenylephrine infusion. 1 There are several aspects of the case that we believe require careful consideration before concluding that phenylephrine was the cause of compartment syndrome.…”

Intraoperative acute compartment syndrome of the upper limb secondary to extravasation

“…These agents are also directly toxic to tissues and can cause necrosis within 6 hours 4. There were two similar cases of vasopressor extravasation in the last 15 years, of which, one case had to undergo limb amputation4 and the other had sensory deficits at latest follow-up 13. However, both cases had significant lengths of time until surgical intervention; a few days in the former4 and 12 hours in the latter 13.…”

“…There were two similar cases of vasopressor extravasation in the last 15 years, of which, one case had to undergo limb amputation4 and the other had sensory deficits at latest follow-up 13. However, both cases had significant lengths of time until surgical intervention; a few days in the former4 and 12 hours in the latter 13. The severe consequences of these two cases were not seen in the case presented, possibly because it was only minutes between onset of symptoms and surgical intervention.…”

Efficacy Evaluation of Amniotic Membrane in the Treatment of Neonatal Extravasation: a Pilot Study

“…Most extravasation injuries are Grades 1 & 2 and do not require treatment [8]. Many interventions are introduced for treatment as hyaluronidase [9], saline irrigation [10], Topical nitroglycerin 2% ointment [11], phentolamine [12], Subcutaneous Terbutaline [13]. Another method that has been noted recently is the usage of the Amniotic membrane (AM).…”