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Acute neck cellulitis and mediastinitis complicating a continuous interscalene block
Xavier Capdevila1, Samir Jaber, Pertti Pesonen
1Department of Anesthesiology and Critical Care Medicine, Lapeyronie University Hospital, Avenue du Doyen G Giraud, Montpellier, France. x-capdevila@chu-montpellier.fr
Anesthesia and Analgesia
|September 23, 2008
Summary
A continuous interscalene brachial plexus block led to severe neck cellulitis and mediastinitis in a patient. Strict aseptic techniques are crucial during catheter insertion and local anesthetic management to prevent serious infections.
Area of Science:
- Anesthesiology
- Infectious Disease
Background:
- Continuous interscalene brachial plexus blocks are used for shoulder surgery analgesia.
- Complications, though rare, require careful consideration and management.
Observation:
- A 61-year-old male developed neck pain post-surgery, progressing to neck edema, erythema, fever, and fatigue.
- Imaging revealed an interscalene abscess, sternocleidomastoid cellulitis, and acute mediastinitis.
Findings:
- Blood and surgical cultures identified Staphylococcus aureus as the causative agent.
- Infection was successfully treated with surgical debridement and a course of antibiotics (vancomycin, imipenem, oxacillin).
Implications:
- The study highlights the risk of infection from continuous regional anesthesia techniques.
- Emphasizes the critical need for stringent aseptic protocols during catheter placement and infusate handling to prevent severe complications.
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