Severe and persistent nerve palsy after ultrasound-guided continuous interscalene brachial plexus block in a teenager undergoing shoulder surgery: a case report
Tóm tắt
Although neurologic sequela is a recognized complication after interscalene brachial plexus block (ISB), there is a paucity of information on how severe and persistent neuropathy occurs and develops. A healthy high school soccer goalkeeper was scheduled for an arthroscopic Bankart repair. After continuous ISB for 2 days, sensation in the C5 and C6 areas and motor function did not return. With symptomatic drug treatment for neuropathic pain and rigorous rehabilitation, recovery of sensory loss and muscle weakness were gradually observed around 1 to 2 months after surgery. He returned to sport 1 year after surgery. This report is the first detailed description of a case who incurred severe and persistent nerve injury after continuous ISB yet recovered nearly fully to return to being an athlete. The present case should also underscore the importance of close observation after surgery in cases where a patient receives continuous ISB.
Tài liệu tham khảo
Wiegel M, Gottschaldt U, Hennebach R, Hirschberg T, Reske A. Complications and adverse effects associated with continuous peripheral nerve blocks in orthopedic patients. Anesth Analg. 2007;104:1578–82.
Borgeat A, Dullenkopf A, Ekatodramis G, Nagy L. Evaluation of the lateral modified approach for continuous interscalene block after shoulder surgery. Anesthesiology. 2003;99:436–42.
Mariano ER, Loland VJ, Ilfeld BM. Interscalene perineural catheter placement using an ultrasound-guided posterior approach. Reg Anesth Pain Med. 2009;34:60–3.
Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965–74.
Pollock JE. Transient neurologic symptoms: etiology, risk factors, and management. Reg Anesth Pain Med. 2002;27:581–6.
Verlinde M, Hollmann MW, Stevens MF, Hermanns H, Werdehausen R, Lirk P. Local anesthetic-induced neurotoxicity. Int J Mol Sci. 2016;17:339.
Radwan IA, Saito S, Goto F. The neurotoxicity of local anesthetics on growing neurons: a comparative study of lidocaine, bupivacaine, mepivacaine, and ropivacaine. Anesth Analg. 2002;94:319–24.
Selander D. Neurotoxicity of local anesthetics: animal data. Reg Anesth. 1993;18:461–8.
Muguruma T, Sakura S, Saito Y. Epidural lidocaine induces dose-dependent neurologic injury in rats. Anesth Analg. 2006;103:876–81.
Seddon HJ. Three types of nerve injury. Brain. 1943;66:237–88.
Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74:491–516.
Chhabra A, Ahlawat S, Belzberg A, Andreseik G. Peripheral nerve injury grading simplified on MR neurography: as referenced to Seddon and Sunderland classifications. Indian J Radiol Imaging. 2014;24:217–24.
Borgeat A, Aguirre J, Curt A. Case scenario: neurologic complication after continuous interscalene block. Anesthesiology. 2010;112:742–5.
Koff MD, Cohen JA, McIntyre JJ, Carr CF, Sites BD. Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis. Anesthesiology. 2008;108:325–8.