Paralysie récurrentielle et syndrome de Claude Bernard-Horner après blocage interscalénique du plexus brachial

Brachial plexus block is commonly used for upper limb surgery. Although the procedure is safe, it may be associated with some life-threatening complications. We performed right-sided supraclavicular brachial plexus block for below-elbow amputation in a 45-year-old female. At completion of the block the patient developed marked respiratory difficulty with audible inspiratory stridor. Although SpO(2) decreased to 82% initially, it was increased to 100% by continuous positive airway pressure with a face mask. On conventional direct laryngoscopy, the left vocal cord was found to be in the midline position and the right vocal cord was in the paramedian position. The trachea was intubated and surgery proceeded without any other complication. Postoperative indirect laryngoscopy revealed that the left vocal cord was fixed, whereas the right vocal cord was mobile, and diagnosis of pre-existing incomplete left vocal cord paralysis was made. This clinical report is to emphasize the importance of thorough pre-operative evaluation of the vocal cord in patients who have undergone any surgical procedure or radiation treatment of the neck before planning for brachial plexus block. If such an evaluation cannot be obtained, an alternative technique, for example axillary approach, should be preferred.

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Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

Solanki

Jain

Makkar

et al. 2011

J Anesth

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Prevention and treatment of neurological complications of the upper extremity following local anesthesia

Dagrenat¹,

Vaienti

Merle³

et al. 2003

Techniques in Regional Anesthesia and Pain Management

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Bilateral Vocal Cord Palsy following Interscalene Brachial Plexus Nerve Block

Plit

Chhajed

Macdonald

et al. 2002

Anaesth Intensive Care

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Acute respiratory complications of an interscalene brachial plexus block include ipsilateral phrenic nerve and recurrent laryngeal nerve palsies. A 71-year-old woman who had undergone a total thyroidectomy for papillary carcinoma 35 years ago was administered a right interscalene brachial plexus block for a shoulder hemi-arthroplasty. Subsequently she developed acute respiratory distress associated with marked stridor secondary to an acute right vocal cord palsy, which was superimposed on what was assumed to be a preexisting left-sided vocal cord palsy. On extubation the patient was noted to develop stridor again necessitating reintubation and tracheostomy was performed two weeks later. The vocal cord palsies failed to resolve over the subsequent 18-month follow-up. We describe this case to highlight the significant risk of this procedure in patients with preexisting or suspected contralateral vocal cord palsy.

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Paralysie récurrentielle et syndrome de Claude Bernard-Horner après blocage interscalénique du plexus brachial

Cited by 3 publications

References 6 publications

Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

Prevention and treatment of neurological complications of the upper extremity following local anesthesia

Bilateral Vocal Cord Palsy following Interscalene Brachial Plexus Nerve Block

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