Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy
Joint Authors
Koogler, Andrew T.
Kushelev, Michael
Source
Case Reports in Anesthesiology
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-5, 5 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-01-03
Country of Publication
Egypt
No. of Pages
5
Main Subjects
Abstract EN
A 76-year-old male presented for reverse total shoulder arthroplasty (TSA) in the beach chair position.
A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach.
On POD 2, the catheter was removed.
Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm.
Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy.
The patient decided to continue conservative management and declined further invasive testing or treatment.
He was followed for one year postoperatively with moderate improvement of his exertional dyspnea over that period of time.
The close proximity of the phrenic nerve to the brachial plexus in combination with its frequent anatomical variation can lead to unintentional mechanical trauma, intraneural injection, or chemical injury during performance of ISB.
The only previously identified risk factor for PPNP is cervical degenerative disc disease.
Although PPNP has been reported following TSA in the beach chair position without the presence of a nerve block, it is typically presumed as a complication of the interscalene block.
Previously published case reports and case series of PPNP complicating ISBs all describe nerve blocks performed with either paresthesia technique or localization with nerve stimulation.
We report a case of a patient experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.
American Psychological Association (APA)
Koogler, Andrew T.& Kushelev, Michael. 2018. Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy. Case Reports in Anesthesiology،Vol. 2018, no. 2018, pp.1-5.
https://search.emarefa.net/detail/BIM-1137114
Modern Language Association (MLA)
Koogler, Andrew T.& Kushelev, Michael. Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy. Case Reports in Anesthesiology No. 2018 (2018), pp.1-5.
https://search.emarefa.net/detail/BIM-1137114
American Medical Association (AMA)
Koogler, Andrew T.& Kushelev, Michael. Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy. Case Reports in Anesthesiology. 2018. Vol. 2018, no. 2018, pp.1-5.
https://search.emarefa.net/detail/BIM-1137114
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1137114