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Abstract
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Background and Aims Although regional anesthesia provides prolonged postoperative analgesia, there is no suitable method that can facilitate early reversal of the blockade until the duration of action of the local anesthetic has elapsed. A large quantity of saline is used to reverse the central neuraxial block. However, to the best of our knowledge, a few study has reported a method for reversing nerve blockade in peripheral nerve blocks.
Methods A 75-year-old man underwent right shoulder rotator cuff repair under general anesthesia. A continuous costoclavicular block was administered for postoperative analgesia. The postoperative pain was well-controlled and the pain score was 0 on the VAS. However, he was unable to moving his arm with absent proprioception, which showed signs of complete anesthesia. Hence, we injected a small amount of saline under ultrasound guidance to confirm the pattern of spread and the absence of nerve swelling due to injection. There were no signs of needle- and catheter-induced nerve damage. Then, we decided to stop the PCA for neurological examination to rule out surgical factor. However, the patient already could move his arm and complained of pain at that time.
Results Unexpected reversal to normal sensory and motor function was observed within approximately 15 minutes after the injection of 15mL of saline.
Ultrasound image of continuous costoclavicular block. AA: Axillary artery, AV: Axillary vein, BP: Brachial plexus, SC: Subclavius muscle, SA: Serratus anterior muscle, Arrows: catheter
Conclusions In conclusion, we observed a dramatic reversal of sensory and motor nerve blockade within a short time following 0.9% saline injection after a costoclavicular block. Our findings suggest that saline injection can be used to reverse the local anesthesia induced by the costoclavicular block.
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