2022 Volume 35 Issue 3 Pages 116-121
Norepinephrine is recommended to be administered via the central venous route. However, in the emergency field, norepinephrine is often given from the peripheral vascular route. The present case was a 59-year-old man with a history of chronic renal failure who had a shunt on his left forearm. Norepinephrine was injected through the peripheral vascular route of the right forearm because pyogenic spondylitis caused septic shock. On the 18th day after extravasation of norepinephrine, he was referred to our department. At the time of surgery, all extensor tendons were necrotic, and the joint capsule of his wrist was necrotic. The joint capsule was reconstructed using the tensor fascia lata, and the soft tissue was reconstructed using anterolateral thigh flap. Since there was no flexor tendon injury, certain activities of daily living were possible with the use of a wrist extension orthotic device. In this case, the antagonist phentolamine was not administered, leading to widespread soft tissue necrosis. Extravasation of drugs is an iatrogenic disorder and requires efforts to reduce the extent of damage as much as possible. Norepinephrine, which is the most frequently used vasoconstrictor, should be documented and all staff involved should be informed, including treatment with antagonists.
