Peripheral Nerve Blockade for Patients With Raynaud Phenomenon and Other Causes of Digital Ischemia: A Case Report and Practice Implications.

Raynaud phenomenon can be an idiopathic benign disease, or it can be associated with vascular insufficiency due to arterial disease caused by other processes. Medical management of Raynaud phenomenon can be difficult, and digital ischemia, gangrene, and ulcers may occur secondary to vascular insufficiency. This case report describes the anesthetic management of a patient with a diagnosis of Raynaud phenomenon who presented to the perioperative area for débridement and distal amputation of the right third finger, which had become necrotic and gangrenous. An ultrasound-guided supraclavicular nerve block was performed preoperatively with 15 mL of 1.5% mepivacaine and 15 mL of 0.5% bupivacaine. The block was performed without complication, and the patient tolerated the procedure. A review of literature related to the use of peripheral nerve blockade for the treatment of digital ischemia is discussed. Ultrasound-guided technique is considered the gold standard for the performance of peripheral nerve blocks because this technique provides better efficacy and safety. These same ultrasonographic skills can expand anesthesia providers' practice beyond nerve blockade for anesthesia and analgesia with the addition of treatment and management of digital ischemia.

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Name: Sarah A. Stephas, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Paul Hertel, DNP, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None. Name: Paul Bennetts, PhD, CRNA Contribution: This author made significant contributions to the conception, synthesis, writing, and final editing and approval of the manuscript to justify inclusion as an author. Disclosures: None The authors did not discuss off-label use within the article. Disclosure statements are available for viewing upon request.