Abstract
Purpose
Ambulatory continuous infusions have been associated with improved analgesia and few serious complications. This report describes
an unusual case of a patient with a continuous interscalene nerve block who developed a contralateral upper extremity sensory
block. The complication did not occur until postoperative day two while the patient was at home.
an unusual case of a patient with a continuous interscalene nerve block who developed a contralateral upper extremity sensory
block. The complication did not occur until postoperative day two while the patient was at home.
Clinical features
A 56-yr-old woman had a continuous interscalene catheter placed for arthroscopic lysis of adhesions of her shoulder. The insertion
needle was initially injected with 0.5% ropivacaine 25 mL (1:400,000 epinephrine), producing a unilateral interscalene block.
Postoperatively, the patient was started on a continuous interscalene infusion of 0.2% ropivacaine at 8 mL·hr−1 via a disposable infusion pump. The next day, the patient had a unilateral brachial plexus block and an associated Horner’s
syndrome and was discharged home with the infusion. On the morning of the second postoperative day, the patient developed
ipsilateral and contralateral Horner’s syndrome with associated numbness in both shoulders. The catheter was removed and symptoms
resolved four hours later.
needle was initially injected with 0.5% ropivacaine 25 mL (1:400,000 epinephrine), producing a unilateral interscalene block.
Postoperatively, the patient was started on a continuous interscalene infusion of 0.2% ropivacaine at 8 mL·hr−1 via a disposable infusion pump. The next day, the patient had a unilateral brachial plexus block and an associated Horner’s
syndrome and was discharged home with the infusion. On the morning of the second postoperative day, the patient developed
ipsilateral and contralateral Horner’s syndrome with associated numbness in both shoulders. The catheter was removed and symptoms
resolved four hours later.
Conclusions
Ambulatory continuous infusions are typically associated with few serious complications and a favourable safety profile. This
case demonstrates that unexpected complications can still occur even after days of normal operation. Based on our previous
experience, we believe this to be a rare but potentially serious event that requires awareness by those discharging patients
with continuous infusions of local anesthetics.
case demonstrates that unexpected complications can still occur even after days of normal operation. Based on our previous
experience, we believe this to be a rare but potentially serious event that requires awareness by those discharging patients
with continuous infusions of local anesthetics.
- Authors
- Joshua Dooley, Duke University Medical Center Department of Anesthesiology Box 3094 Durham NC 27710 USA
- Mitchell Fingerman, Duke University Medical Center Department of Anesthesiology Box 3094 Durham NC 27710 USA
- Steve Melton, Duke University Medical Center Department of Anesthesiology Box 3094 Durham NC 27710 USA
- Stephen M. Klein, Duke University Medical Center Department of Anesthesiology Box 3094 Durham NC 27710 US
- Journal Canadian Journal of Anesthesia / Journal canadien d'anesthésie
- Online ISSN 1496-8975
- Print ISSN 0832-610X
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