J Korean Pain Soc.  2004 Dec;17(2):266-270. 10.3344/jkps.2004.17.2.266.

Postoperative Analgesia in Dyspneic Patient after Interscalene Brachial Plexus Block with General Anesthesia: A case report

• Ryu TH
• Jeon YH
• Lim DG

• KMID: 2104869
• DOI: http://doi.org/10.3344/jkps.2004.17.2.266

Abstract

A 46 year old, ASA physical status I, 50 kg and 160 cm woman, with left shoulder calcific tendonitis, presented for surgical excision of calcium deposits. Preoperative examinations were within normal limits, with the exception of the 1st degree AV block on ECG. Interscalene brachial plexus block, with 20 ml of 0.75% ropivacaine, was carried out prior to general anesthesia. The intra-operative course was uneventful. She complained of dyspnea and chest discomfort in the recovery room, and her SpO2 dropped to 89%. A chest X-ray showed an upward displacement of the left hemidiaphragm and she could not maintain a head lift for 5 seconds. She was diagnosed with left ipsilateral hemidiaphragmatic paresis and residual neuromuscular blockade. She was treated with oxygen inhalation under deep breathing. The dyspnea recovered 3 hours after brachial plexus block and a continuous infusion of 0.2% ropivacaine, which were started for pain control. Three days later, she was discharged without any complications. It was concluded that the respiratory movement should be carefully observed following interscalene brachial plexus block with general anesthesia, especially during recovery of anesthesia.

Keyword

brachial plexus block; hemidiaphragmatic paresis; interscalene block; phrenic nerve block

MeSH Terms

Analgesia*
Anesthesia
Anesthesia, General*
Atrioventricular Block
Brachial Plexus*
Calcium
Dyspnea
Electrocardiography
Female
Head
Humans
Inhalation
Middle Aged
Neuromuscular Blockade
Oxygen
Paresis
Recovery Room
Respiration
Shoulder
Tendinopathy
Tendons
Thorax
Calcium
Oxygen