Internal Medicine Program, School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
Assistant Professor of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR.
P R Health Sci J. 2020 Sep;39(3):278-280.
Multiple case reports have signaled a rise in buprenorphine abuse in the US, particularly among inmates. We present the case of limb ischemia secondary to accidental intra-arterial buprenorphine/naloxone film injection successfully treated with sublingual nitroglycerin. A 39-year-old man with history of intravenous drug use presented sudden severe left hand pain since three days prior to evaluation. Pain was preceded by self-injection of dissolved buprenorphine/naloxone sublingual film onto the affected arm. An arteriogram suggested severe vasoconstriction in the absence of frank thrombosis. Patient was initially treated with continuous heparin infusion and nifedipine. Forty-eight hours later, due to poor response, sublingual nitroglycerin was added to therapy. Digits regained color, sensation, and pain resolved within 15 minutes of administration of sublingual nitroglycerin. The presence of acute limb ischemia caused by prolonged vasospasm is a very rare complication. A normal angiogram should raise suspicion regarding vasospasm as the mechanism of ischemia, and prompt nitroglycerin therapy.
多例病例报告显示，美国的丁丙诺啡滥用现象有所增加，尤其是在囚犯中。我们报告了一例因意外动脉内注射丁丙诺啡/纳洛酮薄膜引起的肢体缺血病例，该病例成功地接受了舌下硝酸甘油治疗。一名 39 岁男性，有静脉吸毒史，在就诊前三天突然出现严重的左手疼痛。疼痛前，他将溶解的丁丙诺啡/纳洛酮舌下薄膜注射到受影响的手臂上。血管造影显示严重的血管收缩，但没有明显的血栓形成。患者最初接受连续肝素输注和硝苯地平治疗。48 小时后，由于反应不佳，加用舌下硝酸甘油治疗。舌下含服硝酸甘油后 15 分钟内，手指恢复颜色、感觉和疼痛消失。由长时间血管痉挛引起的急性肢体缺血是一种非常罕见的并发症。正常的血管造影应该怀疑血管痉挛是缺血的机制，并及时给予硝酸甘油治疗。
