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Case Reports
. 2013 Summer;13(2):267-9.

Importance of vigilant monitoring after continuous nerve block: lessons from a case report

Gopakumar Sudhakaran Nair  1 , Loran Mounir Soliman, Kamal Maheshwari, Wael Ali Sakr Esa
Affiliations
Case Reports

Importance of vigilant monitoring after continuous nerve block: lessons from a case report

Gopakumar Sudhakaran Nair et al. Ochsner J. 2013 Summer.

Abstract

Introduction: Continuous peripheral nerve block achieves good pain control. However, uncontrolled pain despite an effective block in the target areas of the nerve can be an early sign of ischemia. We report a case of iatrogenic injury to the axillary artery during shoulder surgery in a patient who had continuous supraclavicular block and demonstrate how vigilant monitoring helped the diagnosis and resulted in timely management of upper limb ischemia.

Case report: A 58-year-old female underwent total revision surgery of her right shoulder under continuous supraclavicular block. Postoperatively, she complained of pain along the medial side of her forearm despite clinical evidence of nerve block. Continuous neurovascular monitoring and timely angiography confirmed axillary artery injury, and subsequent vascular repair saved the patient's limb.

Conclusion: Iatrogenic injuries to vessels or nerves sometimes occur during orthopedic surgical procedures. Regional anesthesia can mask and delay the onset of these symptoms. Postoperative monitoring and the ability to differentiate between the effects of local anesthetics and the body's response to ischemia are important for avoiding postoperative complications. This case report aims to improve awareness about the need for vigilant monitoring of the distal pulses after peripheral nerve blocks.

Keywords: Autonomic nerve block; axillary artery; pain–postoperative.

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Conflict of interest statement

The authors have no financial or proprietary interest in the subject matter of this article.

References

    1. Wilson JS, Miranda A, Johnson BL, Shames ML, Back MR, Bandyk DF. Vascular injuries associated with elective orthopedic procedures. Ann Vasc Surg. 2003 Nov;17(6):641–644. Epub 2003 Oct 13. - PubMed
    1. Shoenfeld NA, Stuchin SA, Pearl R, Haveson S. The management of vascular injuries associated with total hip arthroplasty. J Vasc Surg. 1990 Apr;11(4):549–555. - PubMed
    1. Calligaro KD, Dougherty MJ, Ryan S, Booth RE. Acute arterial complications associated with total hip and knee arthroplasty. J Vasc Surg. 2003 Dec;38(6):1170–1177. Erratum in: J Vasc Surg. 2004 Mar;39(3):628. - PubMed
    1. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. 2009 Jan;102(1):3–11. Epub 2008 Nov 19. - PubMed
    1. Ilfeld BM, Wright TW, Enneking FK, Morey TE. Joint range of motion after total shoulder arthroplasty with and without a continuous interscalene nerve block: a retrospective, case-control study. Reg Anesth Pain Med. 2005 Sep-Oct;30(5):429–433. - PubMed

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