Reactions 1331 - 11 Dec 2010

SBupivacaine

Brachial plexus palsy and Horner’s syndromefollowing paravertebral infusion in an elderlypatient: case report

A 76-year-old woman developed left brachial plexuspalsy and Horner’s syndrome during paravertebral infusionof bupivacaine for postoperative pain relief.

The woman, who had undergone a lobectomy for anadenocarcinoma 3 years prior, underwent a thoracoscopicwedge resection for a new left upper lobe opacity.Following the procedure, a subpleural pocket was createdin the paravertebral space and a catheter was inserted forinfusion of 0.25% bupivacaine [infusion rate not stated] viaan elastomeric pump. Postoperatively, she was ambulatingeasily and her pain was well-controlled. On the evening ofpostoperative day 1, she was unable to hold her fork withher left hand, and her left eyelid had begun to noticeablydroop. Examination revealed reduced motor strength andsensation in the distribution of C5 to C8 nerves, with miosisand ptosis involving the left eye. A clinical diagnosis of leftbrachial plexus palsy and Horner’s syndrome secondary tobupivacaine infusion was made.

The infusion was discontinued. The woman’s weaknessand numbness completely resolved over the subsequent12 hours. She was discharged the following day, andcontinued to recover without incident.D’Souza D, et al. Transient brachial plexus palsy: An unusual complication ofparavertebral infusion of local anesthetic. Annals of Thoracic Surgery 90: e75-e76,No. 5, Nov 2010. Available from: URL: http://dx.doi.org/10.1016/j.athoracsur.2010.07.071 - USA 803045299

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Reactions 11 Dec 2010 No. 13310114-9954/10/1331-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved