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Lower lobe collapse during continuous interscalene brachial plexus local anesthesia at home
Anand M Sardesai1, Anil J Chakrabarti, Nicholas M Denny
1Department of Anesthesia, Queen Eliabeth Hospital, King's Lynn, United Kingdom. Sardesail@aol.com
Regional Anesthesia and Pain Medicine
|January 17, 2004
Summary
Pulmonary collapse occurred after home administration of interscalene local anesthetic infusion. This case emphasizes crucial patient education and interdisciplinary communication for managing potential complications like diaphragmatic paresis.
Area of Science:
- Anesthesiology
- Pulmonary Medicine
- Patient Safety
Background:
- Interscalene brachial plexus blocks are common for shoulder surgery.
- Home infusion of local anesthetics offers extended analgesia but carries risks.
- Pulmonary complications following regional anesthesia require careful monitoring.
Purpose of the Study:
- To report a case of pulmonary collapse after home-administered interscalene local anesthetic infusion.
- To highlight the importance of patient education regarding postoperative anesthesia management.
- To underscore the need for improved communication between anesthesiologists and other medical specialties.
Main Methods:
- A case report of a 52-year-old male undergoing rotator cuff repair.
- Preoperative interscalene catheter placement for continuous ropivacaine infusion.
- Postoperative home infusion and subsequent hospital readmission due to respiratory distress.
Main Results:
- The patient developed left lower lobe pulmonary collapse within 24 hours of discharge.
- Symptoms included chest pain and dyspnea, initially managed by non-anesthesiologists unfamiliar with the block's sequelae.
- Diaphragmatic paresis secondary to the interscalene block was suspected as the cause.
Conclusions:
- Effective patient education on continuous regional anesthesia is vital.
- Clear communication protocols are necessary to inform non-anesthesiology teams about potential block-related complications.
- Awareness of interscalene block-induced diaphragmatic dysfunction can prevent diagnostic delays.