Ultrasound-Guided Interscalene Catheter Difficult by Persistent Phrenic Nerve Palsy.
Case Rep Anesthesiol. 2018;2018:9873621
Authors: Koogler AT, Kushelev M
A 76-year-old male introduced for reverse complete shoulder arthroplasty (TSA) within the seashore chair place. A preoperative interscalene nerve catheter was positioned beneath direct ultrasound-guidance using a posterior in-plane strategy. On POD 2, the catheter was eliminated. Three weeks postoperatively, the affected person reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated proper hemidiaphragm. Pulmonary operate testing revealed worsening deficit from presurgical values according to phrenic nerve palsy. The affected person determined to proceed conservative administration and declined additional invasive testing or remedy. He was adopted for one yr postoperatively with reasonable enchancment of his exertional dyspnea over that time period. The shut proximity of the phrenic nerve to the brachial plexus together with its frequent anatomical variation can result in unintentional mechanical trauma, intraneural injection, or chemical damage throughout efficiency of ISB. The one beforehand recognized threat issue for PPNP is cervical degenerative disc illness. Though PPNP has been reported following TSA within the seashore chair place with out the presence of a nerve block, it’s usually presumed as a complication of the interscalene block. Beforehand printed case stories and case collection of PPNP complicating ISBs all describe nerve blocks carried out with both paresthesia method or localization with nerve stimulation. We report a case of a affected person experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.
PMID: 29535876 [PubMed]