Acute Dystonic Reaction in the Upper Extremity Following Anesthesia

We present a case of an 83-year-old female who underwent carpal tunnel release with intravenous regional anesthesia (Bier block) and monitored anesthesia care (MAC). After surgery, the patient developed an abnormal motion of her upper extremity, which was treated as an acute dystonic reaction. Dystonic reactions can occasionally be seen as a post-anesthetic complication, but they are most often associated with antidopaminergic medications. Limbs are rarely affected by dystonic reactions, as they usually affect the head and neck. Acute dystonic reactions can be easily treated with diphenhydramine or benzodiazepines to prevent other extrapyramidal symptoms from occurring. The differential, in this case, was widely varied and inappropriate treatment would have been detrimental to patient care.