Abstract
Abstract Interscalene brachial plexus block is a common regional anesthesia method for upper extremity surgery. A rare complication of this procedure is dyspnea secondary to phrenic nerve palsy and hemidiaphragm paralysis. In our case, this rare complication diagnosed using ultrasound led to the diagnosis of a previously asymptomatic pulmonary embolism. The use of ultrasonography was key in the diagnosis of the iatrogenic nerve palsy and was part of a multiple-modality diagnostic workup for her hypoxemia.
Highlights
The use of brachial plexus blocks has been widely accepted as a safe and reliable method of anesthesia for upper extremity surgical procedures
Transient phrenic nerve palsy resulting in hemidiaphragm paralysis is a common side effect of the procedure that rarely produces symptoms [2]
There have only been a small number of case reports on symptomatic dyspnea related to hemidiaphragm paralysis during interscalene blocks
Summary
The use of brachial plexus blocks has been widely accepted as a safe and reliable method of anesthesia for upper extremity surgical procedures. There have only been a small number of case reports on symptomatic dyspnea related to hemidiaphragm paralysis during interscalene blocks While all these cases involved patients with symptomatic respiratory distress, clinical hypoxemia was reported only once [3]. Ultrasound evaluation of the right diaphragm showed no movement with inspiration, including forcible inspiration and expiration by the patient (Fig. 2) This finding supported the diagnosis of phrenic nerve palsy secondary to the interscalene block. At this point, the patient started to improve clinically. Given the ultrasound diagnosis of hemidiaphragm paralysis and the patient’s clinical improvement, as the short acting component of the nerve block was wearing off, consideration was given to canceling the CT angiography. Heparin was started in the ED, and the patient was admitted for observation and conversion to oral anticoagulation therapy
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