Prolonged Interscalene Blockade for 30 Hours with 0.5% Plain Bupivacaine in a Case of Shoulder Arthroscopy

Area of Science:

• Anesthesiology
• Neurology
• Ultrasound-guided regional anesthesia

Background:

• Interscalene block is a common regional anesthesia technique for shoulder surgery.
• Ultrasound guidance improves block success and safety.
• Bupivacaine is a frequently used local anesthetic for prolonged procedures.

Observation:

• A patient experienced an unusually prolonged motor and sensory block of 30 hours after a single-injection interscalene block.
• The block was performed using 0.5% plain bupivacaine under ultrasound guidance.
• Standard safety precautions, including negative aspiration and slow injection, were meticulously followed.

Findings:

• The prolonged block duration (30 hours) was significantly longer than typically expected for this procedure and local anesthetic.
• No evidence of neurological injury was observed in the patient.
• Ultrasound confirmed appropriate spread of the local anesthetic around the C5 and C6 nerve roots.

Implications:

• This case underscores the importance of vigilance for prolonged nerve blocks after regional anesthesia.
• Clinicians should be prepared to manage and investigate potential nerve-related complications, even with standard safety protocols.
• Further investigation may be warranted to understand the factors contributing to such prolonged effects and to refine management strategies.