Early diagnosis and treatment management with USG in a patient who developed unilateral diaphragmatic paralysis after interscalene block

Zülfü Çevik, Deniz Kara, Ayda Türköz

Department of Anesthesiology and Reanimation, Bezmialem Vakıf University Faculty of Medicine, İstanbul, Türkiye

Keywords: Diaphragmatic paralysis, interscalene brachial plexus block, perioperative analgesia, phrenic nerve palsy, thoracic ultrasonography.

Abstract

Interscalene brachial plexus block is frequently used for anesthesia and analgesia in shoulder, clavicle, and humerus surgeries. However, complications such as infection, hematoma, vascular injury, local anesthetic toxicity, nerve damage, total spinal anesthesia, diaphragmatic paralysis, and Horner syndrome may occur after an interscalene block. In this case report, a case of unilateral diaphragmatic paralysis that developed after an ultrasound-guided interscalene brachial plexus block for intraoperative and postoperative analgesia, which was rapidly diagnosed and treated bedside with ultrasound, is presented and discussed. We believe that ultrasound has become an indispensable means of monitoring anesthesia practice, both in peripheral nerve block and in the diagnosis and treatment of complications, in recent years.