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Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation: A lesson why we should use low concentrated local anesthetics for continuous blocks.

Abstract 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.
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Journal Title medicine
Publication Year Start




PMID- 28403100
OWN - NLM
STAT- MEDLINE
DA  - 20170413
DCOM- 20170427
LR  - 20170430
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 15
DP  - 2017 Apr
TI  - Delayed bilateral vocal cord paresis after a continuous interscalene brachial
      plexus block and endotracheal intubation: A lesson why we should use low
      concentrated local anesthetics for continuous blocks.
PG  - e6598
LID - 10.1097/MD.0000000000006598 [doi]
AB  - 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. PATIENT CONCERNS: A 59 year 
      old woman was planned for open acromioplasty and rotator cuff repair under
      general anesthesia. General anesthesia was induced following an ISB using 0.2%
      ropivacaine and catheter insertion for postoperative pain control. DIAGNOSES:
      While recovering in the postanesthesia care unit (PACU), however, the patient
      complained of a sore throat and hoarseness without respiratory insufficiency. On 
      the morning of the first postoperative day, she still complained of mild dyspnea,
      dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral
      vocal cord paresis following an endoscopic laryngoscopy examination.
      INTERVENTIONS: The continuous ISB catheter was immediately removed and the
      dyspnea and hoarseness symptoms improved, although mild aspiration during
      drinking water was still present. OUTCOMES: On the 4th postoperative day, a
      laryngoscopy examination revealed that the right vocal cord movement had returned
      to normal but that the left vocal cord paresis still remained. LESSONS: When ISB 
      is planned, a detailed history-taking and examination of the airway are essential
      for patient safety and we recommend that any local anesthetics be carefully
      injected under ultrasound guidance. We also recommend the use of low
      concentration of local anesthetics to avoid possible paralysis of the vocal cord.
FAU - Park, Hee-Sun
AU  - Park HS
AD  - Department of Anesthesiology and Pain Medicine, Asan Medical Center, University
      of Ulsan College of Medicine, Seoul, Korea.
FAU - Kim, Ha-Jung
AU  - Kim HJ
FAU - Ro, Young-Jin
AU  - Ro YJ
FAU - Yang, Hong-Seuk
AU  - Yang HS
FAU - Koh, Won-Uk
AU  - Koh WU
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anesthetics, Local)
SB  - AIM
SB  - IM
MH  - Anesthetics, Local/administration & dosage/adverse effects
MH  - Brachial Plexus Block/*adverse effects/methods
MH  - Female
MH  - Hoarseness/etiology
MH  - Humans
MH  - Intubation, Intratracheal/*adverse effects
MH  - Middle Aged
MH  - Pharyngitis/etiology
MH  - Postoperative Complications/*etiology
MH  - Postoperative Period
MH  - Vocal Cord Paralysis/*etiology
PMC - PMC5403097
EDAT- 2017/04/14 06:00
MHDA- 2017/04/28 06:00
CRDT- 2017/04/14 06:00
AID - 10.1097/MD.0000000000006598 [doi]
AID - 00005792-201704140-00033 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(15):e6598. doi: 10.1097/MD.0000000000006598.

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