Distressing upper extremity phantom limb sensation during intravenous regional anesthesia

Background and Objectives: The objective of this article is to describe a c ase of distressing upper extremity phantom limb sensation during intravenou s regional anesthesia (IVRA). Case Report: A 33-year-old American Society of Anesthesiologists (ASA) stat us I female with an uncomplicated intrauterine gestation presented for endo scopic carpal tunnel release. Following gravity-assisted exsanguination of the vertically positioned left upper extremity, she underwent an IVRA. With in minutes of her arm being repositioned for surgery she remarked that the arm felt as if it was still in the vertical position. This sensory disturba nce was described as fatiguing and exhausting. Despite reassurance and medi cation with intravenous narcotics her symptoms became intolerable. Her phan tom sensation disappeared upon dissipation of the IVRA. Conclusions: There are no previous reports regarding the development of pha ntom phenomena during an IVRA. The occurrence of distressing phantom sensat ions during an otherwise adequate IVRA may be interpreted as block failure and may lead to conversion to general anesthesia. Practitioners are encoura ged to consider these phenomena when performing IVRA.