Bloqueio do nervo frênico após realização de bloqueio do plexo braquial pela via interescalênica: relato de caso

Abstract

BACKGROUND AND OBJECTIVES:Phrenic nerve block is a common adverse event of brachial plexus block. However, in most cases it does not have any important clinical repercussion. The objective of this work was to report a case with phrenic nerve block with respiratory repercussions in a patient with chronic renal failure who had an extensive arteriovenous fistula created under perivascular interscalene brachial plexus block. CASE REPORT:A 50-year old male patient, smoker, with chronic renal failure on hemodialysis, hypertension, hepatitis C, diabetes mellitus, and chronic obstructive pulmonary disease, was scheduled for creation of an arteriovenous fistula in the right upper limb under interscalene brachial plexus block. The brachial plexus was identified by a peripheral nerve stimulator. Thirty-five milliliter of a local anesthetic mixture containing equal parts of 2% lidocaine with epinephrine at 1:200.000 and 0.75% ropivacaine were injected. After the injection, the patient was alert and oriented, but developed dyspnea and predominance of intercostal respiration on the side of the blockade. Breath sounds were not present in the right base. SpO 2 was maintained at 95% with oxygen through nasal cannula. Institution of invasive ventilatory support was not necessary. A chest X-ray showed the right hemidiaphragm on the 5 th intecostal space. The patient returned to normal after three hours. CONCLUSION:In this case, the patient developed complete paralysis of the phrenic nerve with respiratory symptoms. Although invasive treatment was not necessary, it is necessary to alert anesthesiologists to restrict the indication of this technique.

Hemi-diaphragmatic paresis following extrafascial versus conventional intrafascial approach for interscalene brachial plexus block: A double-blind randomised, controlled trial

“…[45] Attempts being made to reduce the side effects due to ISB have been inconsistent. [678] The occurrence of increasing number of postoperative neurological deficits where ISB method is used to give local anaesthesia has been attributed to harmful needle–nerve contact. [9] A cadaveric study concluded that difficulty with ultrasound discrimination of tissue layers may contribute to subepineurial injection in as many as 50% of intrafascial ISB procedures.…”

Raquianestesia total após bloqueio de gânglio estrelado em paciente com síndrome dolorosa complexa regional: relato de caso

“…A potentially common adverse effect is Horner syndrome, caused by the propagation of the anesthetic drug through the cervical sympathetic trunk, and hoarseness, caused by recurrent laryngeal nerve block. Bilateral block is avoided due to risk of phrenic nerves block, which may result in bilateral palsy of the diaphragm and in ventilatory intercurrences 12 . Life-threatening complications are usually caused by inadvertent anesthetic injection in nearby arteries (subclavian and vertebral arteries) or Total spinal anesthesia after stellate ganglion block in complex regional pain syndrome patient.…”

Analgesic efficacy of ultrasound-guided interscalene block vs. supraclavicular block for ambulatory arthroscopic rotator cuff repair

“…1 The procedure is associated with significant postoperative pain and effective analgesia is required for successful day-case surgery. 2,3 Although ISB, 4 and more particularly continuous interscalene catheter block, is considered to be the most effective analgesic technique for ARCR, 5 it is frequently associated with phrenic nerve block, 6,7 even with the use of ultrasound and low volumes of local anaesthetic. 8 The difficulties in implementing and monitoring a perineural catheter at home have led to many anaesthesiologists to choose a single injection technique so that patients can be discharged on the same day as surgery with a satisfactory level of pain control.…”