RESPIRATORY FAILURE AFTER ACCIDENTAL PHRENIC NERVE BLOCK IN REGIONAL ANESTHESIA OF THE BRACHIAL PLEXUS VIA INTERSCALENE

Abstract

Objective: To describe a form of ventilatory complication resulting from regional anesthesia of the brachial plexus, accidental blockade of the phrenic nerve and its consequences on the respiratory system. Methodology: This is a descriptive study, in the format of a case report, carried out in GoiâniaGO. Data were collected through analysis of electronic medical records. The collected information was discovered with the pre-existing literature through the search of correlated articles in the PubMed/Medline and SCIELO database. Case report: A 42-year-old patient with severe sequelae and total limitation of movement of him right arm because of a car accident, attended for care of the left rotator cuff via arthroscopy, received general balanced anesthesia and regional anesthesia guided by ultrasound via interscalene and who in the post-anesthesia recovery room evolved with acute respiratory failure as a result of the right frantic nerve block. The patient was maintained on ventilatory support until the end of the effect of regional anesthesia and recovery of respiratory function. Conclusion: The patient reported here presented significant ventilatory dysfunction and diaphragmatic paralysis, due to possible involvement of the phenic nerve, after performing an interscalene block for arthroscopic surgery of the brachial plexus. Thus, he could have benefited from a supraclavicular blockade, which provides satisfactory analgesia and less chance of blocking the phrenic nerve, or in the case of maintaining the choice for the interscalene route, the blockade could have been performed with the lowest volume and concentration of local anesthetics.