Transient Hypertension after an Interscalene Block-The Presentation of a Rare Complication with an Anatomical Explanation

Abstract

We would like to report 2 cases where we encountered a rare complication of hypertension without tachycardia after the administration of an interscalene block. We have tried to explain the same with the anatomical correlations.Sameer mahamud Jahagirdar, C. raJeSh Prabhu, S. ParthaSarathy InTRoduCTIon Case capsule 1:A 55 year old male patient had a history of the fall of a coconut on his left arm and he had sustained a fracture on the mid shaft of the humerus. He was posted for the open reduction and the internal fixation of the left humerus. The preoperative evaluation of the patient revealed a pulse rate of 62 per min, a regular and a blood pressure of 170 / 90 mm Hg and a respiratory rate of 18/ min. Electrocardiography revealed left ventricular hypertrophy by the voltage criteria and 2 D echocardiography showed a grade I diastolic dysfunction, no regional wall motion abnormality, and a trivial aortic, mitral and tricuspid regurgitation with no clots in the chambers. The other systemic examinations were unremarkable. The laboratory investigations revealed anaemia (a haemoglobin concentration of 7.1), which was optimized with blood transfusions. The other investigations were unremarkable. The patient was optimized with the cardiac medications; Tab. Atorvastatin 20 mg OD and Tab. Amlodipine 2.5 mg OD for a week and he was then taken for surgery.

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

“…Hypertension is a rare complication after the interscalene nerve block. [ 17 ] Hypertension without tachycardia was detected in two patients in our study. The patients had no previous diagnosis of hypertension.…”

“…Different clinical symptoms are seen according to the affected anatomical structure. [ 17 ] Hoarseness (0.6 to 22%) and Horner's syndrome (0.7 to 29%) were common complications reported in the literature. [ 18 , 19 ] In our series, similar to the literature, hoarseness developed in 0.58% (n=1) and Horner's syndrome in 1.7% (n=3).…”