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Bilateral interscalene

Hee-Sun Park, Ha-Jung Kim, Young-Jin Ro, Hong-Seuk Yang, Won-Uk Koh
RATIONALE: Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck...
April 2017: Medicine (Baltimore)
Ross Mattox, Patrick J Battaglia, Aaron B Welk, Yumi Maeda, Daniel W Haun, Norman W Kettner
OBJECTIVE: The aim of this study was to establish reference values for the width of the interval between the anterior and middle scalene muscles using ultrasonography during varying degrees of glenohumeral joint (GH) abduction. Reliability and body mass index (BMI) data were also assessed. METHODS: Interscalene triangles of asymptomatic participants were scanned bilaterally in the transverse plane. Images were obtained at 0°, 90°, and 150° of GH abduction with the participant seated...
November 2016: Journal of Manipulative and Physiological Therapeutics
Gabriel Enrique Mejia-Terrazas, María de Ángeles Garduño-Juárez, Marisol Limón-Muñoz, Areli Seir Torres-Maldonado, Raúl Carrillo-Esper
BACKGROUND: The bilateral brachial plexus block is considered a contraindication, due to the possible development of complications, such as: toxicity from local anaesthetics or bilateral diaphragmatic paralysis. However, with the real time visualisation provided by the ultrasound scan, these complications have decreased and it is a safer procedure. CLINICAL CASES: Four cases are presented where the bilateral block was performed using guided ultrasound, as the patients were unable to receive general anaesthesia due to a history of adverse effects or the use of opioids in the post-operative or by the prediction of a difficult airway associated with obesity...
July 2015: Cirugia y Cirujanos
Gerhard Fritsch, Martin Hudelmaier, Thomas Danninger, Chad Brummett, Matthias Bock, Mark McCoy
BACKGROUND AND OBJECTIVES: Interscalene brachial plexus blockade is widely used in surgical procedures of the upper limb. Recently, we experienced the complication of a contralateral blockade after ultrasound-guided interscalene block. The clinical appearance was a blockade of both the ipsilateral and the contralateral cervical segments 6 to 8. We hypothesized that epidural spread of local anesthetics could be cause for this phenomenon. METHODS: We conducted a cadaveric study using ultrasound for needle guidance of interscalene blocks in 5 cadavers by a single investigator using contrast agent...
January 2013: Regional Anesthesia and Pain Medicine
Nigel Hollister, Harith Altemimi, Martyn West
The authors report an unusual case of post extubation stridor resulting in insertion of a tracheostomy. Regional anaesthesia using interscalene nerve blockade in the presence of an unrecognised contralateral recurrent laryngeal nerve palsy resulted in bilateral recurrent laryngeal nerve palsies. The authors discuss the differential causes of stridor and recurrent laryngeal nerve palsy, their importance and way of identification on preoperative assessment.
2011: BMJ Case Reports
Souvik Chaudhuri, Md Gopalkrishna, Cherish Paul, Ratul Kundu
Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization...
April 2012: Journal of Anaesthesiology, Clinical Pharmacology
Kristofer S Matullo, Ian C Duncan, John Richmond, Katharine Criner, Carson Schneck, F Todd Wetzel
STUDY DESIGN: Cadaver dissection and measurement. OBJECTIVE: To describe a previously undocumented intracostal ligament that limits the potential space through which the T1 ventral ramus passes before joining the C8 ventral ramus. SUMMARY OF BACKGROUND DATA: Preclavicular entrapment of the T1 ventral ramus can lead to radiculopathy, neurogenic thoracic outlet syndrome, or both, the so called "double crush" phenomenon. The usual sites of entrapment include the neural foramen, the interscalene interval, an aberrant cervical rib, the first rib itself, or an apical thoracic mass...
November 1, 2010: Spine
J Holborow, G Hocking
Regional anaesthesia for bilateral upper limb surgery can be challenging, yet surgeons are becoming increasingly interested in performing bilateral procedures at the same operation. Anaesthetists have traditionally avoided bilateral brachial plexus block due to concerns about local anaesthetic toxicity, phrenic nerve block and pneumothorax. We discuss these three concerns and review whether advances in ultrasound guidance and nerve catheter techniques should make us reconsider our options. A search of Medline and EMBASE from 1966 to January 2009 was conducted using multiple search terms to identify techniques of providing anaesthesia or analgesia for bilateral upper limb surgery and potential side-effects...
March 2010: Anaesthesia and Intensive Care
Emmett E Whitaker, Anthony L Edelman, John H Wilckens, Jeffrey M Richman
The case of a 43 year-old woman who underwent successful right interscalene brachial plexus block for arthroscopic shoulder surgery is presented. During the surgery, she subsequently exhibited signs of neuraxial spread of local anesthetic. Bilateral motor block was noted postoperatively. Spontaneous ventilation was maintained throughout the case, and she was successfully discharged home several hours after the procedure with no residual symptoms.
March 2010: Journal of Clinical Anesthesia
Yoshitaka Tanaka, Mitsuhiro Aoki, Tomoki Izumi, Mineko Fujimiya, Toshihiko Yamashita, Tomohito Imai
BACKGROUND: Thoracic outlet syndrome is thought to be caused by compression of the brachial plexus or subclavian artery in the interscalene, costoclavicular, or subcoracoid space. Some provocative tests are widely used for diagnosing thoracic outlet syndrome. However, whether provocative positions actually compress the neurovascular bundle in these spaces remains unclear. The purpose of this study was to investigate the possibility of neurovascular bundle compression in the costoclavicular space by measuring the pressure applied to the brachial plexus and subclavian artery in provocative positions...
January 2010: Journal of Orthopaedic Science: Official Journal of the Japanese Orthopaedic Association
Daniel W Haun, John C S Cho, Thomas B Clark, Norman W Kettner
OBJECTIVE: Ultrasonography has been used to measure the cross-sectional area (CSA) of peripheral nerves, but the CSA of the brachial plexus has not previously been reported. The purpose of this study was to establish a reference range of values for the CSA of the brachial plexus, subclavian artery, and peak systolic velocity (PSV) of the subclavian artery in healthy subjects using ultrasonography. METHODS: Thirty-two asymptomatic subjects (19 men, 13 women) from a chiropractic college with an average age of 29...
September 2009: Journal of Manipulative and Physiological Therapeutics
Hugh M Smith, Christopher M Duncan, James R Hebl
OBJECTIVE: The purpose of this series is to describe cases in which ultrasound guidance was used to allow patients to receive the benefits of regional anesthesia while safely circumventing traditional contraindications to interscalene blockade (ISB). METHODS: Targeted low-volume ISB was performed in 3 patients in whom this procedure would typically be contraindicated because of phrenic nerve blockade or risk of local anesthetic toxicity. A patient with severe respiratory dysfunction, a patient undergoing bilateral shoulder surgery, and a patient requiring awake fiberoptic intubation underwent low-volume ultrasound-guided ISB...
September 2009: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Eric M Samuelson, Gustavo X Cordero, Edward V Fehringer
Reverse shoulder arthroplasty may be indicated in shoulders that cannot be effectively managed by conventional reconstruction procedures. Reported complications include instability, infection, hematoma, scapular notching, and premature component loosening. To our knowledge, however, fracture of a humeral component polyethylene inlay has not been described. A 72-year-old man presented with unstable, painful shoulders after undergoing unsuccessful open repairs and acromioplasties at an outside institution for bilateral massive rotator cuff tears...
March 2009: Orthopedics
Kenneth E Langen, Kenneth D Candido, Michael King, Guido Marra, Alon P Winnie
BACKGROUND: A decreased latency of onset of neural blockade has been noted when muscular exercise of the hand was performed after supraclavicular brachial plexus block using lidocaine. In this observational study, we examined the effect of repetitive muscle contraction of the hand on the speed of onset of interscalene brachial plexus block (ISB) using bupivacaine. METHODS: Forty patients were enrolled, all of whom received an ISB as one component of their anesthetic management for elective arthroscopic shoulder surgery...
February 2008: Anesthesia and Analgesia
Derya Demirbag, Ercument Unlu, Ferda Ozdemir, Hakan Genchellac, Osman Temizoz, Huseyin Ozdemir, M Kemal Demir
OBJECTIVES: To investigate the differences in findings from magnetic resonance imaging (MRI) in the neutral and provocative positions, and to examine the relationship between these differences and the results of physical examination tests in patients with thoracic outlet syndrome (TOS). DESIGN: Prospective. SETTING: University physical medicine and rehabilitation outpatient and radiology clinics. PARTICIPANTS: Twenty-nine patients and 12 healthy controls...
July 2007: Archives of Physical Medicine and Rehabilitation
G Feigl, A Fuchs, M Gries, Q H Hogan, B Weninger, W Rosmarin
Interscalene blocks of the brachial plexus are used for surgery of the shoulder and are frequently associated with complications such as temporary phrenic block, Horner syndrome or hematoma. To minimize the risk of these complications, we developed an approach that avoids medially directed needle advancement and favors spread to lateral regions only: the supraomohyoidal block. We tested this procedure in 11 cadavers fixed by Thiel's method. The insertion site is at the lateral margin of the sternocleidomastoid muscle at the level of the cricoid cartilage...
August 2006: Surgical and Radiologic Anatomy: SRA
M L Plit, P N Chhajed, P Macdonald, I E Cole, G A Harrison
Acute respiratory complications of an interscalene brachial plexus block include ipsilateral phrenic nerve and recurrent laryngeal nerve palsies. A 71-year-old woman who had undergone a total thyroidectomy for papillary carcinoma 35 years ago was administered a right interscalene brachial plexus block for a shoulder hemi-arthroplasty. Subsequently she developed acute respiratory distress associated with marked stridor secondary to an acute right vocal cord palsy, which was superimposed on what was assumed to be a preexisting left-sided vocal cord palsy...
August 2002: Anaesthesia and Intensive Care
Konrad Maurer, Georgios Ekatodramis, Jürg Hodler, Katharina Rentsch, Henry Perschak, Alain Borgeat
No abstract text is available yet for this article.
March 2002: Anesthesiology
Konrad Maurer, Georgios Ekatodramis, Katharina Rentsch, Alain Borgeat
UNLABELLED: Brachial plexus blockade is a suitable technique for surgery of the forearm, because it provides good intraoperative anesthesia as well as prolonged postoperative analgesia when long-acting local anesthetics are used. However, simultaneous blockade of both upper extremities has rarely been performed (1), because local anesthetic toxicity caused by the amount of drug needed to achieve an efficient block on both sides may be a problem. We report a case of successful bilateral brachial plexus block with ropivacaine in a patient with bilateral distal radius fracture, with each fracture requiring an open osteosynthesis...
February 2002: Anesthesia and Analgesia
B C Bowen, A Verma, A H Brandon, J A Fiedler
A 54-year-old man had a slowly progressive bilateral brachial plexopathy 17 months after surgery and radiation therapy for a stage IV supraglottic carcinoma. MR imaging at presentation showed a symmetric pattern of parascalene and interscalene hyperintense signal on T2-weighted images and after contrast enhancement. Although hyperintense signal has been more often associated with recurrent tumor than with delayed radiation injury or fibrosis, the location and pattern of the signal abnormalities suggested a diagnosis of radiation-induced plexopathy...
November 1996: AJNR. American Journal of Neuroradiology
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