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.