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Case Reports
. 2016 Jun;95(24):e3891.
doi: 10.1097/MD.0000000000003891.

Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block: A case report

Helen Ki Shinn  1 , Byung-Gun Kim, Jong Kwon Jung, Hee Uk Kwon, Chunwoo Yang, Jonghun Won
Affiliations
Case Reports

Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block: A case report

Helen Ki Shinn et al. Medicine (Baltimore). 2016 Jun.

Erratum in

  • Erratum: Medicine, Volume 95, Issue 24: Erratum.
    [No authors listed] [No authors listed] Medicine (Baltimore). 2016 Aug 7;95(31):e5074. doi: 10.1097/01.md.0000490009.39850.74. eCollection 2016 Aug. Medicine (Baltimore). 2016. PMID: 31265618 Free PMC article.

Abstract

Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. However, it is generally transient and is resolved over the duration of the local anesthetic's action.We present a case of a patient who experienced prolonged hemidiaphragmatic paresis following a continuous interscalene brachial plexus block for the postoperative pain management of shoulder surgery, and suggest a mechanism that may have led to this adverse effect.Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Preoperative chest X-ray.
Figure 2
Figure 2
Chest X-ray at 3 months showing an elevation of the right hemidiaphragm associated with basal atelectasis of the right lower lobe and pleural effusion.
Figure 3
Figure 3
Chest X-ray at 15 months postoperatively showing fully expanded lungs.
See this image and copyright information in PMC

References

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    1. Yang CW, Jung SM, Cho CK, et al. Pleural effusion and atelectasis during continuous interscalene brachial plexus block -A case report. Korean J Anesthesiol 2010;58:95–8. - PMC - PubMed

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