Reactions 1327 - 13 Nov 2010

Ropivacaine

Contralateral upper extremity sensory block andHorner’s syndrome: case report

A 56-year-old woman developed contralateral Horner’ssyndrome and upper extremity sensory block followingunilateral ropivacaine interscalene nerve block for shouldersurgery.

The woman, who had adhesive capsulitis of the rightshoulder, was scheduled for athroscopic lysis of adhesions.She received 0.5% ropivacaine 25mL (1:400,000epinephrine) initially for a unilateral interscalene block. Amulti-orifice continuous catheter was then inserted andplaced near the brachial plexus. After an uncomplicatedprocedure, she received a continuous infusion of 0.2%ropivacaine at 8 mL/hr via a disposable infusion pump. Thenext morning she was unable to flex her right arm at theelbow but could move all of her fingers. She experiencedlack of sensation in her fourth and fifth fingers with atingling feeling on her first, second and third fingers,accompanied by ipsilateral Horner’s syndrome, whichpersisted throughout the day. She was discharged onpostoperative day 1, receiving a continuous ropivacaineinfusion. Two days after surgery, she experienced bilateralHorner’s syndrome with continued numbness in her fourthand fifth fingers of the right hand. In addition, she hadnumbness from the left shoulder to her elbow.

The woman removed the catheter, and 2 hours later, sheregained sensation and had normal motor function in bothupper extremities with complete resolution of heripsilateral Horner’s syndrome. Four hours following theremoval of the catheter, her contralateral Horner’ssyndrome had resolved.

Author comment: "The fact that symptoms were notdetected until postoperative day 2 is very unusual andsuggests that this complication occurred from gradual spreadof local anesthetic or migration of the catheter from its initialposition."Dooley J, et al. Contralateral local anesthetic spread from an outpatientinterscalene catheter. Canadian Journal of Anaesthesia 57: 936-939, No. 10, Oct2010. Available from: URL: http://dx.doi.org/10.1007/s12630-010-9360-y -USA 803043158

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Reactions 13 Nov 2010 No. 13270114-9954/10/1327-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved