Author(s): ,
Cai, Y.*
Mayo Clinic, Anesthesiology, Jacksonville, USA
Clendenen, S.
Mayo Clinic, Anesthesiology, Jacksonville, USA
ESRA Academy. Cai Y. Sep 13, 2017; 190868

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Background and Aims:

Peripheral small vessel vasospastic disease can be devastating, resulting in pain, tissue ischemia, and loss of function.   Regional nerve blocks have been shown by Doppler ultrasound to increase blood flow in medium to large sized vasculature, but there is no data on small vessels.  We present a case of painful vasospasm in the hands undetectable by Doppler and ameliorated by brachial plexus block.


A 64-year-old female with a history of steatohepatitis, hypertension, and chronic kidney disease presented with one week of painful, cool, and cyanotic digits (Fig. 1).  Doppler studies in both the venous and arterial phase were unremarkable, and the patient was started on aspirin, nifedipine, and topical nitroglycerin with no improvement. The patient underwent bilateral ultrasound guided supraclavicular catheter placement. A baseline arteriogram was obtained on the right side followed by a 15 milliliter bolus of 1.5% lidocaine through the catheter followed by arteriograms. This was replicated on the left side. 


On both sides, the blocks resulted in decreased pain and flushing in the upper extremities.  Angiography indicated increased luminal diameter of vasculature (Fig. 2). Two months post-procedure, the patient continues on medical therapy with no pain and improved digital blood flow.


We report a diagnostic tool in distinguishing vasospasm versus an occlusive disorder of small vessels by correlation of a block and vasodilation demonstrated by angiography. This presents the possibility of regional anesthesia as part of the acute management of ischemia related to small caliber vasospastic disease.

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