Contralateral local anesthetic spread from an outpatient interscalene catheter.
Summary of "Contralateral local anesthetic spread from an outpatient interscalene catheter."
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
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.
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.
Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
This article was published in the following journal.
Name: Canadian journal of anaesthesia = Journal canadien d'anesthesie
- 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
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.
A widely used local anesthetic agent.
Acetanilide derivative used as a local anesthetic.
A thiophene-containing local anesthetic pharmacologically similar to MEPIVACAINE.
PURPOSE OF REVIEW: The review examines recent research activity in the field of continuous peripheral nerve blocks in the ambulatory setting and places it in context with regard to previous research e...
PURPOSE: To retrospectively report on a series of patients who had interscalene block regional anesthesia performed for outpatient open and arthroscopic shoulder surgical procedures in a community-bas...
PURPOSE: The epidural electrical stimulation test (EEST) is a highly specific and sensitive test for confirming placement of the epidural catheter in the epidural space. The purpose of this study was...
PURPOSE: The placement of continuous peripheral nerve catheters on an ambulatory basis is increasing and is routine at our institution. There are few reports of complications associated with periphera...
PURPOSE: Local anesthetic adjuvants have been studied previously in an attempt to prolong the duration of analgesia after peripheral nerve blockade. Magnesium has been shown to h...
This study is designed to compare interscalene catheter insertion distances, in order to determine which is the best for pain relief after shoulder surgery.
Peripheral nerve blocks provide many advantages for patients (excellent pain control and reduction in nausea) undergoing upper and lower limb surgery however several commonly occurring com...
Research study to determine if putting local anesthetic through a tiny tube next to the nerves that go to the shoulder will improve shoulder range-of-motion following the shoulder procedur...
Interscalene brachial plexus block (ISBPB) is a common nerve block given to patients who are undergoing shoulder surgery. This block has a low, but still significant, rate of complications...
Objective: To determine a minimally effective initial local anesthetic bolus required to provide satisfactory analgesia using continuous brachial plexus infusion following arthroscopic sho...