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Background and Aims Interscalene brachial plexus block (ISB) is commonly used for anesthesia and postoperative analgesia for shoulder, clavicle and humerus surgeries. Its complications are related to the nervous and vascular structures, such as nerve injury, Horner’s syndrome and phrenic nerve block. Ipsilateral recurrent laryngeal nerve block (RLNB) is a rare complication related to ISB, typically manifested by hoarseness.

Methods 34-year-old male, ASA II, was scheduled for intramedullary nailing of the humerus, due to humeral shaft fracture. General anesthesia was induced and the airway secured with tracheal intubation, after which a single-shot ultrasound-guided ISB was performed, resulting in the administration of 13mL of 0.5% ropivacaine (65mg).

Results Hemodynamic and respiratory stability were maintained throughout the intraoperative period. Following the surgery, neuromuscular block was reversed and the patient had an uneventful emergence. The patient was clinically stable, but exhibited hoarseness. He was then transferred to the Post-Anesthesia Care Unit, where ultrasound was used to assess vocal cord mobility and diaphragmatic function, revealing paresis of both the ipsilateral vocal cord and hemidiaphragm. RLNB and phrenic nerve block were assumed, having spontaneously reversed after a period of watchful waiting, resulting in complete clinical resolution.

Conclusions Hoarseness after shoulder surgery is a rare but known complication with multiple etiologies, including ISB-related neuropraxia and RLNB. In these cases, patient reassurance is paramount, and a watchful waiting approach should be employed, allowing time for a block to reverse.