An Unusual Complication of Brachial Plexus Block and Heparin Therapy

Mani, M; Ramamurthy, Nitin; Rao, Tadikonda L. K.; Winnie, Alon P.; Collins, Vincent J.

doi:10.1097/00000542-197803000-00009

Cited by 8 publications

(5 citation statements)

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“…A case report by Howell, et al described the occurrence of hematoma in the neck following neurostimulation-guided interscalene block [23]. A separate case reported a massive hemopneumothorax following a supraclavicular brachial plexus block [23,24] in a patient who was heparinized [24]. Additionally, we found one case in the literature of massive hemothorax following a supraclavicular block.…”

Section: Case 1: Bilateral Supraclavicular Cathetersmentioning

confidence: 55%

“…Thus, it is quite evident that bilateral blocks of the brachial plexus may lead to bilateral phrenic nerve blockade and complete paralysis of the diaphragm. However, in sound guidance [23][24][25], which has been shown to significantly reduce the rate of complications of these procedures [4,9]. Overall, hematoma is an extremely rare complication, particularly when ultrasound guidance is utilized [4].…”

Section: Discussionmentioning

confidence: 99%

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Continuous Bilateral Brachial Plexus Blockade for Acute Pain Control in Patients with Bilateral Upper Extremity Traumatic Injuries: A Review of Five Cases

Sen¹

2017

Clin Med Rev Case Rep

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Study objective: Brachial plexus catheters are typically placed to provide regional anesthesia to the shoulder, arm, forearm, wrist and hand. However, there are risks associated with catheter placement including infection and local anesthetic toxicity. Study design:In this study we discuss five case scenarios where we felt bilateral brachial plexus blocks were appropriate and, if performed with caution, the benefits would outweigh the risks. Each of these patients suffered severe bilateral upper-extremity traumatic injuries, requiring multiple surgical procedures and debridement's while inpatient on the trauma service. These patients were chosen because of the need for pain control during their hospital stay, the appropriateness of these particular techniques, and a lack of absolute contraindications to these techniques. Conclusions:In carefully-selected patients, bilateral brachial plexus catheters can be used safely and effectively to control pain secondary to traumatic injuries to the upper extremities. These catheters are a potentially valuable tool as part of a multimodal pain control regimen, with the goal of achieving adequate pain management, while limiting opioid use.

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Section: Case 1: Bilateral Supraclavicular Cathetersmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Continuous Bilateral Brachial Plexus Blockade for Acute Pain Control in Patients with Bilateral Upper Extremity Traumatic Injuries: A Review of Five Cases

Sen¹

2017

Clin Med Rev Case Rep

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“…that too was attributed to heparin therapy following surgical repair done under brachial plexus block. [ 2 ] Most reported hemothoraces are the result of rib fractures, lung parenchymal, spontaneous hemothorax following pneumothorax. Delayed pneumothorax formation after this block has been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Other less frequent complications of this technique are injury to nerves, phrenic nerve block, Horner's syndrome etc. [ 1 2 ] Although hematoma formation is a known complication after this block but delayed massive hemothorax is a rare complication. Massive hemothorax is commonly caused by a penetrating trauma and less frequently in central venous cannulation, especially in those with coagulopathy.…”

Section: Introductionmentioning

confidence: 99%

Massive hemothorax: A rare complication after supraclavicular brachial plexus block

et al. 2014

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Plexus block is the preferred anesthesia plan for upper limb surgeries. Among the known complications, hematoma formation following the vascular trauma is often occur but this complication is frequently underreported. We present a case where a massive hemothorax developed post operatively in a patient who underwent resection of giant cell tumor of the right hand radius bone followed by arthroplasty under brachial plexus block using supraclavicular approach. This case report attempts to highlight the essence of remaining vigilant postoperatively for first initial days after brachial plexus block, especially after failed or multiple attempts. Ultrasound guided technique in combination with nerve stimulator has proven to be more reliable and safer than traditional techniques.

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“…A delayed retroperitoneal hemorrhage can occur, following the placement of a lumbar plexus block or catheter, wherein systemic anti-coagulation is performed (1). A hemothorax developed following a supraclavicular brachial plexus block, even though systemic heparinization was commenced greater than 4 hours post-procedure (272). The paucity of data on nonneuraxis procedures make it difficult to provide recommendations (1), but systemic heparinization is considered a contraindication (271).…”

Section: Systemic Heparinizationmentioning

confidence: 99%

Bleeding Risk in Interventional Pain Practice: Assessment, Management, and Review of the Literature

Raj¹

2004

Pain Phys

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An Unusual Complication of Brachial Plexus Block and Heparin Therapy

Cited by 8 publications

References 0 publications

Continuous Bilateral Brachial Plexus Blockade for Acute Pain Control in Patients with Bilateral Upper Extremity Traumatic Injuries: A Review of Five Cases

Continuous Bilateral Brachial Plexus Blockade for Acute Pain Control in Patients with Bilateral Upper Extremity Traumatic Injuries: A Review of Five Cases

Massive hemothorax: A rare complication after supraclavicular brachial plexus block

Bleeding Risk in Interventional Pain Practice: Assessment, Management, and Review of the Literature

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