A patient selected for surgery induced with thiopental i.v. through one of the antecubital veins, complains of severe pain of whole hand. What should be the next line of management in this patient?
**Core Concept**
The patient's complaint of severe pain in the whole hand after administration of thiopental through an antecubital vein is likely due to phlebitis or irritation of the vein by the local anesthetic properties of thiopental. This phenomenon is also known as "intra-arterial injection" or "peri-arterial injection" although the actual injection might have been intra-venous.
**Why the Correct Answer is Right**
Thiopental has a local anesthetic property and can cause vasoconstriction when injected into a vein. This can lead to ischemia of the surrounding tissues, including the nerves, causing pain. The correct next line of management is to administer a local anesthetic agent like lidocaine or lidocaine with epinephrine (adrenaline) to relieve pain and prevent further complications. This is because the addition of epinephrine helps to constrict the blood vessels and reduce the flow of the local anesthetic to the area, thereby reducing the risk of further irritation.
**Why Each Wrong Option is Incorrect**
**Option A:** Administering more thiopental would only exacerbate the situation and cause further irritation of the vein.
**Option B:** Using a different type of local anesthetic without epinephrine may not provide sufficient relief and could lead to further complications.
**Option C:** Applying ice to the affected area may provide some temporary relief but does not address the underlying cause of the pain and may not be effective in preventing further complications.
**Option D:** Stopping the surgery and administering sedation may not address the immediate problem of pain and discomfort in the hand.
**Clinical Pearl / High-Yield Fact**
When administering thiopental through a peripheral vein, it is essential to use a large bore needle and to inject the drug slowly to minimize the risk of peri-arterial injection and subsequent pain.
**Correct Answer:** C.