contralateral weakness ISB

[aged2]

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pt 35 y/o obese female for rotator cuff repair, no significant medical hx, ISB with 30 CC .5% bupivicaine with 1:100,00 epi, propofol induction LMA, 3% desflurane no CX intraoperativley. Patient positioned with AX. roll and nonoperative arm suported in a neutral position. Has CO of numbness and tingling, and weakness in nonoperative arm. Case lasted 45 min. Anybody know of spread of LA to the contralateral brachial plexus? Or have any other ideas for this cx?

 

[urge]

Sounds like an epidural block.

 

[aged2]

found somthing
http://journals.indexcopernicus.com/fulltxt.php?ICID=559623

Doubt it was epidural pt had block for appro 30 min prior to induction with no CO weakness in contralateral arm.

 

[Idiopathic]

how can this not be positioning?

 

[Gator05]

Where in the non-operative arm? Anything else besides numbness and tingling? An ISB shouldn't give you much ulnar coverage, vs entrapment which may be selective for the nerve.

The dura can extend quite lateral over the roots to the extent that epidurals are certainly possible.

 

[aged2]

Could be I suppose but patient was positioned correctly and the case was short. In addition the numbness and weakness seem rather severe given the care given to positioning.

 

[militarymd]

found somthing
http://journals.indexcopernicus.com/fulltxt.php?ICID=559623

Doubt it was epidural pt had block for appro 30 min prior to induction with no CO weakness in contralateral arm.

There are zebras out there, but most of the time, it's just a horse.