Recommended Citation
Bawdane K, Lozhou L, Dhargalkar J. Symptomatic hemi-diaphragmatic palsy following rescue interscalene brachial plexus nerve block. Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Presentation Notes
Presented at: Midwest Anesthesia Residents Conference (MARC); April 26, 2025; Indianapolis, IN.
Abstract
Introduction: Proximal humerus/shoulder surgeries usually cause a significant amount of pain in post-operative period and Interscalene brachial plexus (ISB) nerve block promises good pain relief for the same. However, one of the major complications of the interscalene brachial plexus block is hemi -diaphragmatic palsy [1], which can pose a genuine concern for ambulatory surgeries. We hereby present a case of an elderly female who developed symptomatic right hemi diaphragmatic palsy after interscalene brachial plexus block. Case Presentation: This is a 73-year-old female with a past medical history of obesity (BMI 37), HTN, DM type II not on insulin, dyslipidemia, and traumatic right proximal humerus fracture, who got operated for open reduction internal fixation of proximal humerus fracture with repair of right rotator cuff tear under general anesthesia. Intraoperatively she received 200 mcg of Fentanyl for analgesia. The patient complained of severe pain (10/10) after surgery, so she received right sided interscalene block with 20 ml of bupivacaine-Epinephrine (PF ,0.5 % -1:200000) as rescue analgesia in the post operative period. Two hours following the block the patient complained of dyspnea with intermittent desaturations to SpO2 of 60% on room air. X ray chest showed new elevation of right hemidiaphragm with right lower lobe atelectasis, consistent with right hemi diaphragmatic palsy. Patient was admitted overnight on telemetry ward, where she received incentive spirometry and chest physiotherapy, following which she was able to wean off the supplemental oxygen requirement. Conclusion: Transient diaphragmatic palsy is common after interscalene (ISB) nerve block but symptomatic hypoxemia is a rare occurrence. Underlying pulmonary disorders, including obesity can further deplete pulmonary functional reserve following interscalene brachial plexus block. Proper patient selection, timing of block, use of ultrasound or alternative technique of nerve block [2] can plummet the incidence of symptomatic hemi -diaphragmatic palsy. 1. Kang, R. et al. (2023) Anesth Pain Med 18(1):5-10 2. Kim, DH. et al. (2019) Anesthesiology 131(3):521-533
Type
Oral/Podium Presentation
Affiliations
Advocate Illinois Masonic Medical Center