[A case report of hemidiaphragmatic paresis caused by interscalene brachial plexus block]

A 76-yr-old woman was scheduled for left upper extremity orthopedic procedure. Preoperative examinations were within normal limits except forced vital capacity. Interscalene brachial plexus block with 0.25% bupivacaine 15 ml, was performed under general anesthesia. Her intraoperative course was uneventful. She, however, complained of the dyspnea after removal of a tracheal tube, and Spo2 dropped to 89%. A chest X-ray demonstrated the elevation of hemidiaphragm. She was diagnosed as ipsilateral hemidiaphragmatic paresis, treated with oxygen inhalation under deep breathing for approximately one hour, and then transferred to the common ward. We conclude that respiratory movement should be carefully observed following interscalene brachial plexus block especially in geriatric patients.