[Prolonged interscalene block to treat postoperative brachial plexopathy]

A 47-year-old woman developed neuropathic pain in the right brachial plexus after surgery to remove a suprasellar tumor. The main cause was injury to the plexus owing to technical difficulties in the preoperative catheterization of the ipsilateral internal jugular vein. The pain, which was intense and refractory to systemic medication, resolved with a continuous interscalene block with ropivacaine, clonidine, and morphine. The block was continued throughout the rehabilitation period, which lasted 7 weeks to allow recovery with no sequelae. Perioperative neuropathy is a rare but potentially debilitating complication. Injury to the brachial plexus causes neuropathic type pain. Consequent functional changes are difficult to treat and have significant repercussions on quality of life. Current approaches to treatment reduce both central and peripheral neuronal hyperexcitability. A continuous regional block of the brachial plexus to manage refractory neuropathic pain is an effective technique that is seldom mentioned in the literature.