RT Journal Article
SR Electronic
T1 Importance of Vigilant Monitoring After Continuous Nerve Block: Lessons From a Case Report
JF Ochsner Journal
JO Ochsner J
FD O. P. Jindal Global University
SP 267
OP 269
VO 13
IS 2
A1 Gopakumar Sudhakaran Nair
A1 Loran Mounir Soliman
A1 Kamal Maheshwari
A1 Wael Ali Sakr Esa
YR 2013
UL http://www.ochsnerjournal.org/content/13/2/267.abstract
AB Introduction Continuous peripheral nerve block achieves good pain control. However, uncontrolled pain despite an effective block in the target areas of the nerve can be an early sign of ischemia. We report a case of iatrogenic injury to the axillary artery during shoulder surgery in a patient who had continuous supraclavicular block and demonstrate how vigilant monitoring helped the diagnosis and resulted in timely management of upper limb ischemia.Case Report A 58-year-old female underwent total revision surgery of her right shoulder under continuous supraclavicular block. Postoperatively, she complained of pain along the medial side of her forearm despite clinical evidence of nerve block. Continuous neurovascular monitoring and timely angiography confirmed axillary artery injury, and subsequent vascular repair saved the patient's limb.Conclusion Iatrogenic injuries to vessels or nerves sometimes occur during orthopedic surgical procedures. Regional anesthesia can mask and delay the onset of these symptoms. Postoperative monitoring and the ability to differentiate between the effects of local anesthetics and the body's response to ischemia are important for avoiding postoperative complications. This case report aims to improve awareness about the need for vigilant monitoring of the distal pulses after peripheral nerve blocks.