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 Sudden severe postoperative dyspnea following shoulder surgery: Remember inadvertent phrenic nerve block due to interscalene brachial plexus block

Arpit Jariwala1, Pavan Kumar B. C. Raju2, David M Coventry2
1 Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
2 Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom

Correspondence Address:
Arpit Jariwala
Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY
United Kingdom
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6042.137528

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Year : 2014  |  Volume : 8  |  Issue : 2  |  Page : 51-54

 
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Advanced imaging techniques, improved operative techniques, and instrumentation combined with better patient awareness and expectations have resulted in an exponential increase in upper limb surgical procedures during recent times. Surgical teams expect superior analgesia and regional blocks have matched these expectations quite often resulting in improved patient satisfaction and early rehabilitation to achieve best results. Ultrasound-guided interscalene brachial plexus block (ISB) is commonly used to provide analgesia for procedures involving shoulder girdle. We report a case of symptomatic hemi-diaphragmatic paresis (HDP) due to the phrenic nerve block following ISB for arthroscopic sub-acromial decompression of the shoulder presenting as severe postoperative dyspnea. There is strong evidence of HDP following ISB in anesthetic literature, but not reported in related surgical specialties such as orthopedics. We wish to inform upper-limb surgeons and educate junior doctors and other ancillary staff working in upper-limb units to be aware of this serious but reversible complication.






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© 2006 - International Journal of Shoulder Surgery
| Published by Wolters Kluwer - Medknow Online since 1st September '06

 

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Arpit Jariwala1, Pavan Kumar B. C. Raju2, David M Coventry2
1 Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom
2 Department of Anaesthesia, Ninewells Hospital and Medical School, Dundee DD1 9SY, United Kingdom

Correspondence Address:
Arpit Jariwala
Department of Orthopaedics, Ninewells Hospital and Medical School, Dundee DD1 9SY
United Kingdom
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-6042.137528

Rights and Permissions

Advanced imaging techniques, improved operative techniques, and instrumentation combined with better patient awareness and expectations have resulted in an exponential increase in upper limb surgical procedures during recent times. Surgical teams expect superior analgesia and regional blocks have matched these expectations quite often resulting in improved patient satisfaction and early rehabilitation to achieve best results. Ultrasound-guided interscalene brachial plexus block (ISB) is commonly used to provide analgesia for procedures involving shoulder girdle. We report a case of symptomatic hemi-diaphragmatic paresis (HDP) due to the phrenic nerve block following ISB for arthroscopic sub-acromial decompression of the shoulder presenting as severe postoperative dyspnea. There is strong evidence of HDP following ISB in anesthetic literature, but not reported in related surgical specialties such as orthopedics. We wish to inform upper-limb surgeons and educate junior doctors and other ancillary staff working in upper-limb units to be aware of this serious but reversible complication.






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Sitemap | What's New | Copyright and Disclaimer
© 2006 - International Journal of Shoulder Surgery
| Published by Wolters Kluwer - Medknow Online since 1st September '06