Contralateral local anesthetic spread from an outpatient interscalene catheter.
Summary of "Contralateral local anesthetic spread from an outpatient interscalene catheter."
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. 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.
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.
Affiliation
Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
Journal Details
This article was published in the following journal.
Name: Canadian journal of anaesthesia = Journal canadien d'anesthesie
ISSN: 1496-8975
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20652841
- DOI: http://dx.doi.org/10.1007/s12630-010-9360-y
Medical and Biotech [MESH] Definitions
Dibucaine
A local anesthetic of the amide type now generally used for surface anesthesia. It is one of the most potent and toxic of the long-acting local anesthetics and its parenteral use is restricted to spinal anesthesia. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1006)
Outpatient Clinics, Hospital
Organized services in a hospital which provide medical care on an outpatient basis.
Bupivacaine
A widely used local anesthetic agent.
Trimecaine
Acetanilide derivative used as a local anesthetic.
Carticaine
A thiophene-containing local anesthetic pharmacologically similar to MEPIVACAINE.
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