A Rare Complication of Intravenous Regional Anesthesia Due to Tourniquet Dysfunction-A Case Report

A 60 year old female was admitted under the diagnosis of carpal tunnel syndrome. Intravenous regional anesthesia (IVRA) was given using a double cuffed tourniquet (7.5 cm cuff and 18 cm in length), and 40 ml of 0.5% lidocaine. After the tourniquet was inflated (250 mmHg) and the anesthetic agent was injected, the patient's left forearm became swollen and ecchymotic spots appeared all over the forearm. We released the tourniquet and the surgical procedure (decompression of median nerve) was performed under general anesthesia (GA). The patient was discharged on the 2(superscript nd) post operation day. The petechiae persisted for 2 weeks, however by the 4(superscript td) week post operation, the forearm and hand were completely recovered without any motor or sensory deficit. We suggest that physicians be aware of the potential risk of IVRA and its complications. When performing hand surgery under IVRA, the appropriate equipment and drugs should be available in case the need to switch to GA. Also, drugs used for cardiopulmonary resuscitation or central nervous system intoxication should be ready.