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Abstract
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Background and Aims A 52-year old male patient, diagnosed with End Stage Renal Disease, came in with a complaint of infected left radiocephalic arteriovenous fistula for renal dialysis access. The site was noted to be erythematous, tender and with abscess formation. The plan was to ligate the fistula under peripheral nerve block.
Methods The anesthetic plan for this patient was a left supraclavicular nerve (SCN) block, to which the patient consented. After aseptic technique, an in-plane ultrasound-guided left supraclavicular block was performed using high–frequency linear transducer above the middle third of the clavicle. A total of 25 ml of Ropivacaine 0.25% with dexamethasone 8mg was injected.
Results A 23-minute soaking time achieved a surgical anesthesia to the operative site. The patient also complained of hoarseness. His hemodynamic parameters were normal, no desaturation, no difficulty of breathing, and no agitation. The patient was reassured then sedated to a Modified Ramsay Sedation Score of 3. The surgery was completed in 57 minutes. Still, with hoarseness noted. He was pain-free for 12 hours. The hoarseness was resolved as soon as the block diminished.
Left Brachial Plexus after 12 hours following Supraclavicular Nerve Block
Conclusions The recurrent laryngeal nerve (RLN) block is common following an interscalene block, but is quite unsual after a SCN block. RLN block has been reported in 1.3% of cases but almost exclusively occur in right SCN block (Gupta,et.al). Hoarseness after left SCN block is attributable to the blockade of fibers of RLN in the left vagus nerve, where the drug deposited moved medially to the left subclavian artery where the vagus nerve sits in proximity.