Reactions 1130 - 2 Dec 2006

Bupivacaine

Peripheral nerve disorders: case reportA 21-year-old man experienced motor-sensory block after

resolution of a supraclavicular plexus block with bupivacaine.The man presented for surgical repair of right elbow valgus

impaction syndrome, and supraclavicular plexus block wasperformed with 0.375% bupivacaine 25mL and epinephrine.Prior to receiving bupivacaine, the needle had been visualisedcontacting the brachial plexus just cephalad and posterior tothe subclavian artery. Twenty-five minutes after the block, hehad decreased sensation to ice in his hand and forearm withalmost complete paresis of wrist extension, flexion and straightfinger abduction. He received IV propofol, fentanyl androcuronium bromide, and open right-elbow arthrotomy andexcision of an osteophyte were performed. Prior to emergencefrom anaesthesia, he had sustained tetany of his orbicularisoris muscle on nerve stimulation, so the neuromuscular blockwas not antagonised.

On arrival in the recovery room, the man had decreasedsensation to ice in his radial, median and ulnar distributions ofhis hand, weakness with wrist extension, flexion and straightfinger abduction, and complete paresis of his biceps muscle.Prior to discharge, these findings persisted, although hereported increased strength and sensation in his hand.However, upon arrival home, he was unable to move or feelhis hand or forearm. He was advised to return to the hospital.Examination revealed a normal incision with minimal swelling,lack of sensation in his entire arm and complete paresis of hisarm and hand. CT findings were normal apart from a smallamount of air by the brachial plexus injection site. He wasadmitted for observation and the block resolved 23 hourspost-placement.Sites BD, et al. An abnormal clinical course of an ultrasound-guidedsupraclavicular brachial plexus block using 0.375% bupivacaine. Journal ofClinical Anesthesia 18: 449-451, No. 6, Oct 2006 - USA 801053260

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Reactions 2 Dec 2006 No. 11300114-9954/10/1130-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved