Weakness of contralateral upper limb after interscalene block - A case report
Ashok Jadon1, Swapnil Nage1, Chintala Pavana Swarupa1
1Department of Anaesthesia and Pain Relief Service, Tata Motors Hospital, Jamshedpur, Jharkhand, India.
Indian Journal of Anaesthesia
|February 13, 2019
Summary
Ultrasound-guided interscalene block for shoulder and elbow surgery can lead to contralateral limb weakness from local anesthetic spread. Prompt intervention prevented serious complications in this case report.
Area of Science:
- Anesthesiology
- Regional Anesthesia
- Pain Management
Background:
- Interscalene brachial plexus block is a common technique for shoulder and elbow surgery.
- Ultrasound guidance enhances block accuracy and safety.
- Postoperative analgesia is crucial for patient recovery.
Observation:
- A patient undergoing surgery for right upper limb injury received an ultrasound-guided interscalene block with an indwelling catheter.
- Postoperatively, the patient developed weakness in the contralateral (left) upper limb.
- This adverse event was attributed to inadvertent spread of local anesthetic into the cervical epidural space.
Findings:
- The case highlights a rare complication of interscalene block: contralateral upper limb weakness.
- Cervical epidural spread of local anesthetic is a potential, though uncommon, pathway.
- Timely recognition and intervention mitigated the severity of the complication.
Implications:
- Awareness of potential anesthetic spread is vital for anesthesiologists performing regional blocks.
- Techniques to minimize epidural spread during interscalene blocks should be considered.
- This case underscores the importance of vigilant postoperative monitoring for unexpected neurological deficits.
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