Guirguis Maged, Karroum Rami, Abd-Elsayed Alaa A, Mounir-Soliman Loran
Ochsner J. 2012 Summer;12(2):159-62.
Brachial plexus blocks have become very common for patients undergoing upper extremity surgery. We report a case in which the patient developed ipsilateral phrenic nerve paralysis and acute respiratory failure following supraclavicular nerve block.
A 61-year-old female diabetic, morbidly obese patient presented for a repeat debridement of necrotizing fasciitis on her left arm. She received a left-sided supraclavicular brachial plexus block. Within a few minutes, the patient began to experience acute dyspnea, anxiety, and oxygen saturation of 90%. Breath sounds were diminished in the left hemithorax. Arterial blood gases revealed evidence of acute respiratory acidosis. The chest x-ray was normal. After induction, we intubated the patient. Subsequent arterial blood gases showed marked improvement in respiratory acidosis. We believed left phrenic nerve paralysis to be the cause of the distress. The patient was extubated in the surgical intensive care unit the following day, and infusion of ropivacaine 0.2% was started. The catheter was removed afterward secondary to its occlusion.
Phrenic nerve injury leading to respiratory distress is a rare complication of supraclavicular brachial plexus block. Anesthesiologists should be ready for emergency intubation when performing this kind of block.
臂丛神经阻滞对于接受上肢手术的患者来说已经非常常见。我们报告一例患者在锁骨上神经阻滞后出现同侧膈神经麻痹和急性呼吸衰竭的病例。
一名61岁的女性糖尿病、病态肥胖患者因左臂坏死性筋膜炎再次清创就诊。她接受了左侧锁骨上臂丛神经阻滞。几分钟内，患者开始出现急性呼吸困难、焦虑，血氧饱和度为90%。左半侧胸廓呼吸音减弱。动脉血气显示存在急性呼吸性酸中毒。胸部X光片正常。诱导后，我们对患者进行了插管。随后的动脉血气显示呼吸性酸中毒有明显改善。我们认为左侧膈神经麻痹是导致该患者不适的原因。患者于次日在外科重症监护病房拔管，并开始输注0.2%的罗哌卡因。之后由于导管堵塞将其拔除。
膈神经损伤导致呼吸窘迫是锁骨上臂丛神经阻滞的一种罕见并发症。麻醉医生在进行此类阻滞时应做好紧急插管的准备。
