A 61-year-old female diabetic, morbidly obese patient presented for a repeat
debridement of
necrotizing fasciitis on her left arm. She received a left-sided supraclavicular
brachial plexus block. Within a few minutes, the patient began to experience acute
dyspnea, anxiety, and oxygen saturation of 90%. Breath sounds were diminished in the left hemithorax. Arterial blood
gases revealed evidence of acute
respiratory acidosis. The chest x-ray was normal. After induction, we intubated the patient. Subsequent arterial blood
gases showed marked improvement in
respiratory acidosis. We believed left phrenic nerve
paralysis to be the cause of the distress. The patient was extubated in the
surgical intensive care unit the following day, and infusion of
ropivacaine 0.2% was started. The
catheter was removed afterward secondary to its occlusion.
CONCLUSION: