Acute and nonacute complications associated with interscalene block and shoulder surgery

Abstract

Background: The incidence, etiology, and evolution of complications after interscalene brachial plexus block (ISB) are not well-known. The authors prospectively monitored 521 patients for complications during the first 9 months after ISB. Methods: A total of 521 adults scheduled for elective shoulder surgery performed with an ISB were included in this prospective study. The ISB procedure was standardized for all patients. Acute complications were recorded. Patients were observed daily (for 10 days) for paresthesias, dysesthesias, pain not related to surgery, and muscular weakness and were evaluated at 1, 3, 6, and 9 months after surgery. Persistence of paresthesias, dysesthesias, pain not related to surgery, or muscular weakness was investigated at 1 or 3 months by means of electroneuromyography. Final evaluation was performed at 9 months. Results: A total of 520 patients completed the study; one was excluded after surgical axillary nerve damage. Two hundred thirty-four patients had an interscalene catheter. Acute complications consisted of one pneumothorax (0.2%) and one episode of central nervous system toxicity (incoherent speech; 0.2%). At 10 days, 74 patients (14%) were symptomatic, and none had muscular weakness. At 1 month, 41 patients (7.9%) had symptoms, and none had muscular weakness. Thirty patients underwent electroneuromyography; sulcus ulnaris syndrome (n=8), carpal tunnel syndrome (n=2), and complex regional pain syndrome (n=1) were diagnosed. At 3 months 20 patients (3.9%) were symptomatic, and none had muscular weakness. All underwent electroneuromyography; carpal tunnel syndrome (n=2), complex regional pain syndrome (n=4), plexus neuropathy (n=1), and plexus damage (n=1) were diagnosed. At 6 months, 5 patients (0.9%) were symptomatic. At 9 months, 1 patient (0.2%) had persistence of dysesthesia. Conclusions: Interscalene brachial plexus block performed with a standardized technical approach, material, and drugs is associated with an incidence of short- and severe long-term complications of 0.4%. In case of persistent paresthesia, dysesthesia, or pain not related to surgery after ISB, sulcus ulnaris syndrome, carpal tunnel syndrome, or complex regional pain syndrome should be excluded since specific treatment may be required.