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Abstract
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Background and Aims Ultrasonography has recently emerged as one of the most valuable equipment for anesthesiologists during the whole perioperative period. The aim of this report is to describe diagnosis and follow-up of a patient who developed phrenic nerve paralysis during interscalene block performed with nerve stimulator.
Methods A 71-year-old woman with known hypertension was scheduled for surgery for supraspinatus muscle tear. The patient underwent an interscalene block with 25 cc 0.5% bupivacaine using nerve stimulator. The patient was transferred to post anesthesia care unit with a possible diagnosis of phrenic nerve paralysis as the SpO2 value was 88% and needed O2 of 8 L/min. Ultrasonographic examination revealed diaphragmatic paralysis as the excursion was only 1.6 cm (figure 1). During the follow-up the patient’s diaphragm movements recovered and she was transferred to ward with an excursion measured 4.1 cm and SpO2 of 96% in room air (figure 2)
Results Interscalene block is associated with hemidiaphragmatic paralysis as a result of phrenic nerve block[1]. It is usually a benign condition and resolves spontaneously but close monitoring may be needed in some cases. In this case, in addition diagnosing the pathology, ultrasound improved patient safety by enabling real-time diaphragm monitoring.
M-mode ultrasonographic imaging of ipsilateral diaphragmatic excursion at the 2nd postoperative hour
M-mode ultrasonographic imaging of ipsilateral diaphragmatic excursion at the 2nd postoperative day
Conclusions In addition to improving safety during regional anesthesia practice, ultrasonography may also play an important role during management of the complications. [2].