Delayed vocal fold paralysis after continuous interscalene level brachial plexus block with catheter placement: a case report

Gollapalli, Lakshman; McKelvey, George; Wang, Hong

doi:10.1016/j.jclinane.2014.02.004

Cited by 6 publications

(6 citation statements)

References 8 publications

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“…There is a previous case report of delayed vocal fold paralysis after continuous ISB with catheter placement that occurred approximately 8 hours after the initial local anesthetics bolus through the ISB catheter. [7] Although our current case differed from that previous patient, she did show delayed aggravation and prolonged bilateral vocal cord paresis signs and symptoms. We speculated that the mild initial symptoms in the PACU were because of the left recurrent laryngeal nerve paresis following trauma from the endotracheal intubation and the delayed aggravation was because of the right recurrent laryngeal nerve paresis following accumulation of local anesthetic through the continuous ISB PCA.…”

Section: Discussioncontrasting

confidence: 77%

“…[7] The right and left recurrent laryngeal nerves arise from the vagus nerve. The right recurrent laryngeal nerve hooks backwards and upward behind the subclavian artery and ascends to the trachea-esophageal groove.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of cases are known to be unilateral and arise on the ipsilateral side of the procedure. [7,8] However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion.…”

Section: Introductionmentioning

confidence: 99%

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Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

Park

Kim

et al. 2017

Medicine

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Rationale:Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck.Patient concerns:A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control.Diagnoses:While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination.Interventions:The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water was still present.Outcomes:On the 4th postoperative day, a laryngoscopy examination revealed that the right vocal cord movement had returned to normal but that the left vocal cord paresis still remained.Lessons:When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid possible paralysis of the vocal cord.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

Park

Kim

et al. 2017

Medicine

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“…Tückisch ist dabei, dass diese Rekurrensparesen nicht unbedingt unmittelbar nach einem Initialbolus des Lokalanästhetikums auftreten müssen. Sie können auch nach zunächst unauffälligem Verlauf bei einliegendem Katheter erst Stunden später klinisch apparent werden [77].…”

Section: Heiserkeit (Nervus-recurrens-blockade)unclassified

Periphere Regionalanästhesie ohne Komplikationen – Ein Traum wird wahr?!

Wiesmann¹,

Döffert²,

Steinfeldt³

2018

Anästhesiol Intensivmed Notfallmed Schmerzther

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Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. Moreover, beside general complications, which might potentially occur in any peripheral nerve blockade ("bleeding/infection/nerve damage"), accidental co-blockades of other nerval structures are discussed using the example of the brachial plexus. In addition to the presentation of the possible complications, this article discusses improvements in the techniques during the last two decades. Due to the use of ultrasound, some side effects nowadays are supposed to occur less likely. An outlook into the future will inform the reader about improved or more selective blockages.

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“…In addition, it has often been associated with complications, such as phrenic nerve palsy 2 6 7) and delayed vocal fold paralysis. 23) …”

Section: Discussionmentioning

confidence: 99%

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Cho

Lee

et al. 2017

Clin Orthop Surg

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BackgroundThe purpose of this study was to compare the results of arthroscopically guided suprascapular nerve block (SSNB) and blinded axillary nerve block with those of blinded SSNB in terms of postoperative pain and satisfaction within the first 48 hours after arthroscopic rotator cuff repair.MethodsForty patients who underwent arthroscopic rotator cuff repair for medium-sized full thickness rotator cuff tears were included in this study. Among them, 20 patients were randomly assigned to group 1 and preemptively underwent blinded SSNB and axillary nerve block of 10 mL 0.25% ropivacaine and received arthroscopically guided SSNB with 10 mL of 0.25% ropivacaine. The other 20 patients were assigned to group 2 and received blinded SSNB with 10 mL of 0.25% ropivacaine. Visual analog scale (VAS) score for pain and patient satisfaction score were assessed 4, 8, 12, 24, 36, and 48 hours postoperatively.ResultsThe mean VAS score for pain was significantly lower 4, 8, 12, 24, 36, and 48 hours postoperatively in group 1 (group 1 vs. group 2; 5.2 vs. 7.4, 4.1 vs. 6.1, 3.0 vs. 5.1, 2.1 vs. 4.2, 0.9 vs. 3.9, and 1.3 vs. 3.3, respectively). The mean patient satisfaction score was significantly higher at postoperative 4, 8, 12, 24, 36, and 48 hours in group 1 (group 1 vs. group 2; 6.7 vs. 3.9, 7.4 vs. 5.1, 8.8 vs. 5.9, 9.2 vs. 6.7, 9.5 vs. 6.9, and 9.0 vs. 7.2, respectively).ConclusionsArthroscopically guided SSNB and blinded axillary nerve block in arthroscopic rotator cuff repair for medium-sized rotator cuff tears provided more improvement in VAS for pain and greater patient satisfaction in the first 48 postoperative hours than blinded SSNB.

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Delayed vocal fold paralysis after continuous interscalene level brachial plexus block with catheter placement: a case report

Cited by 6 publications

References 8 publications

Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

Periphere Regionalanästhesie ohne Komplikationen – Ein Traum wird wahr?!

Comparison of Arthroscopically Guided Suprascapular Nerve Block and Blinded Axillary Nerve Block vs. Blinded Suprascapular Nerve Block in Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

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