Prolonged hemidiaphragmatic paralysis following interscalene brachial plexus block

Ediale, Kode R.; Myung, Chang R.; Neuman, George G.

doi:10.1016/j.jclinane.2004.03.005

Cited by 39 publications

(21 citation statements)

References 8 publications

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“…It can result in subjective dyspnea secondary to ipsilateral hemi-diaphragmatic paralysis and therefore should be performed with caution in patients with significant pulmonary disease. Studies have shown a 100% incidence of hemi-diaphragmatic paralysis following an interscalene block with nerve stimulation [11][12][13]. Decreasing local anesthetic volume and the use of ultrasound has been shown to reduce the incidence of phrenic nerve blockade following an interscalene brachial plexus block [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…The same study showed the incidence with infraclavicular brachial plexus blockade to be much lower at with only 1 patient out of 32 (incidence 3%) developing paresis of the diaphragm. However, such phrenic nerve blockade is transient, and patients can compensate by increasing their respiratory rate and it is not clinically significant in patients without pulmonary disease [13,16,11]. 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.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

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“…A report ascribes the diaphragmatic paralysis after renal transplant to a compression of cervical foraminal roots, due to the position assumed by the patient [17] . Regarding the anesthetic procedure, diaphragmatic paralysis is often associated with the implementation of regional anesthesia with a brachial plexus block [18,19] . Wakeno et al [20] presented a case in which the prone position for seven hours associated with surgery in a diabetic patient played a definite part in causing diaphragmatic paralysis through excessive tissue distension of the neck, but in the immediate postoperative period, they observed the recovery of the physiological respiratory pattern.…”

Section: Discussionmentioning

confidence: 99%

Hemidiaphragm Paralysis after Robotic Prostatectomy: Medical Malpractice or Unforeseeable Event?

et al. 2015

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The authors present a case of suspected malpractice linked to the onset of hemidiaphragm paralysis after robot-assisted radical prostatectomy (RARP). The approach to the case is shown from a medico-legal point of view. It is demonstrated how, after a thorough review of the literature, this was not a case of medical malpractice but an unforeseeable event. This paper aims at contributing to the very few reports dealing with the onset of hemidiaphragm paralysis after RARP, thus fostering clinical knowledge of these rare events and meanwhile providing useful data for the medico-legal handling in case of alleged negligence of surgeons.

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“…Although it is usually considered a safe block, the risk of complications has been reported from between 3 to 10 % [3,4]. Even though the number of moderate to severe complications is low, they present a significant impairment to the patient [5][6][7][8]. Many reasons have been suggested for these types of complications, but it was the intraneural injection which was highlighted as the main cause of severe complications [9].…”

Section: Introductionmentioning

confidence: 99%

Permanent upper trunk plexopathy after interscalene brachial plexus block

Avellanet¹,

Sala‐Blanch

Rodrigo³

et al. 2015

J Clin Monit Comput

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Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block as was dysfunction of the brachial plexus resulting in an inability to perform flexion, abduction and external rotation of the right shoulder. Severe brachial plexopathy was probably due to a local anesthetic having been administrated through the perineurium and into the nerve fascicles. Severe brachial plexopathy is an uncommon but catastrophic complication of IBPB. We propose a clinical algorithm using ultrasound guidance during nerve blocks as a safer technique of regional anesthesia.

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Prolonged hemidiaphragmatic paralysis following interscalene brachial plexus block

Cited by 39 publications

References 8 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

Hemidiaphragm Paralysis after Robotic Prostatectomy: Medical Malpractice or Unforeseeable Event?

Permanent upper trunk plexopathy after interscalene brachial plexus block

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