189 A case of horner’s syndrome after ultrassom-guided interscalene brachial plexus block

Horner’s syndrome results from paralysis of the ipsilateral sympathetic cervical chain (stellate ganglion) caused by surgery, drugs (mainly high concentrations of local anesthetics), local compression (hematoma or tumor), or inadequate perioperative positioning of the patient. It occurs in 100% of the patients with an interscalene block of the brachial plexus and can also occur in patients with other types of supraclavicular blocks.In this case report, we presented a case of Horner’s syndrome after performing an ultrasound-guided infraclavicular brachial plexus block with 15 mL of bupivacaine 0.5%. It appeared 40 minutes after the block with specific triad (ptosis, miosis, and exophtalmia) and quickly disappears within 2 hours and a half without any sequelae. Horner's syndrome may be described as an unpleasant side effect because it has no clinical consequences in itself. For this reason anesthesiologists should be aware of this syndrome, and if it occurs patients should be reassured and monitored closely.

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Evaluating Hemidiaphragmatic Paralysis With Prolonged Neural Blockade From an Interscalene Brachial Plexus Block

Case Medical Research ◽

10.31525/ct1-nct04209504 ◽

2019 ◽

Author(s):

Keyword(s):

Brachial Plexus ◽

Brachial Plexus Block ◽

Interscalene Brachial Plexus Block ◽

Neural Blockade ◽

Plexus Block

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INTERSCALENE BRACHIAL PLEXUS BLOCK WITH A NERVE STIMULATOR FOR CLAVICULAR FRACTURE SURGERY

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2013.6.3 ◽

2014 ◽

pp. 20-24

Author(s):

Van Minh Nguyen

Keyword(s):

Side Effects ◽

Brachial Plexus ◽

Brachial Plexus Block ◽

Clavicle Fracture ◽

Onset Time ◽

Clavicular Fracture ◽

Nerve Stimulator ◽

Interscalene Brachial Plexus Block ◽

Plexus Block ◽

Fracture Surgery

Objective:To evaluate the effectiveness and side effects, complications of interscalene brachial plexus block with a nerve stimulator for clavicular fracture surgery. Materials and Methods:In a prospective descriptive study, fifty patients received interscalene brachial plexus block for fixation of clavicle fracture. The dose was 7 mg/kg of 1% lidocaine mixed with 1 : 200000 adrenaline. Results:The success rate was 94%, including 4% of patients needed sedation and small amount of narcotic, failure rate was 6%. The minimal stimulating current of the nerve location was 0.46 ±0.08 mA, the onset time of sensory block was 8.86 ±2.65min. There were 3 complications with one Horner’s syndrome and two hoarsenesses. Conclusion:We found that in patients undergoing fixation of clavicle fracture the interscalene block with a nerve stimulator was an effective anesthetic with a low rate of side effects and complications. Key words:Interscalene block, nerve stimulator, clavicular fracture surgery.

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Local Anesthetic-Induced Central Nervous System Toxicity during Interscalene Brachial Plexus Block: A Case Series Study of Three Patients

Journal of Clinical Medicine ◽

10.3390/jcm10051013 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1013

Author(s):

Daniel Spitzer ◽

Katharina J. Wenger ◽

Vanessa Neef ◽

Iris Divé ◽

Martin A. Schaller-Paule ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Brachial Plexus ◽

Local Anesthetic ◽

Local Anesthetics ◽

Brachial Plexus Block ◽

Central Nervous System Toxicity ◽

Interscalene Brachial Plexus Block ◽

Plexus Block ◽

System Toxicity

Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

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