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Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block.
Reg Anesth Pain Med. 2011 Mar-Apr; 36(2):198-201.RA

Abstract

BACKGROUND

Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate.

CASE REPORTS

We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral block at T2-3. One patient also developed an ipsilateral hemidiaphragmatic paresis, an adverse effect that has not been reported before. Subsequent radiologic examination revealed a limited thoracic cephalad spread of the radiopaque dye and a laterally ascending spread from the thoracic paravertebral space toward and around the brachial plexus. We offer potential explanations for these phenomena.

CONCLUSIONS

Brachial plexus block can occur by a route parallel to a nerve connecting the second intercostal nerve and T1 nerve, that is, Kuntz nerve. The hemidiaphragmatic paresis was attributed to the ascending spread of local anesthetic toward the area where the phrenic nerve bypasses the subclavian artery and vein.

Authors+Show Affiliations

Anesthesiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. s.renes@anes.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21270722

Citation

Renes, Steven H., et al. "Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block." Regional Anesthesia and Pain Medicine, vol. 36, no. 2, 2011, pp. 198-201.
Renes SH, van Geffen GJ, Snoeren MM, et al. Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block. Reg Anesth Pain Med. 2011;36(2):198-201.
Renes, S. H., van Geffen, G. J., Snoeren, M. M., Gielen, M. J., & Groen, G. J. (2011). Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block. Regional Anesthesia and Pain Medicine, 36(2), 198-201. https://doi.org/10.1097/AAP.0b013e31820d424c
Renes SH, et al. Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block. Reg Anesth Pain Med. 2011 Mar-Apr;36(2):198-201. PubMed PMID: 21270722.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block. AU - Renes,Steven H, AU - van Geffen,Geert J, AU - Snoeren,Miranda M, AU - Gielen,Matthieu J, AU - Groen,Gerbrand J, PY - 2011/1/29/entrez PY - 2011/1/29/pubmed PY - 2011/12/24/medline SP - 198 EP - 201 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 36 IS - 2 N2 - BACKGROUND: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. CASE REPORTS: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral block at T2-3. One patient also developed an ipsilateral hemidiaphragmatic paresis, an adverse effect that has not been reported before. Subsequent radiologic examination revealed a limited thoracic cephalad spread of the radiopaque dye and a laterally ascending spread from the thoracic paravertebral space toward and around the brachial plexus. We offer potential explanations for these phenomena. CONCLUSIONS: Brachial plexus block can occur by a route parallel to a nerve connecting the second intercostal nerve and T1 nerve, that is, Kuntz nerve. The hemidiaphragmatic paresis was attributed to the ascending spread of local anesthetic toward the area where the phrenic nerve bypasses the subclavian artery and vein. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/21270722/Ipsilateral_brachial_plexus_block_and_hemidiaphragmatic_paresis_as_adverse_effect_of_a_high_thoracic_paravertebral_block_ L2 - https://rapm.bmj.com/lookup/pmidlookup?view=long&pmid=21270722 DB - PRIME DP - Unbound Medicine ER -