Severe Postural Respiratory Insufficiency Following Intersca
Phrenic nerve block leading to ipsilateral diaphragmatic paralysis is common following the performance of an interscalene brachial plexus block. The diaphragmatic paralysis is generally well tolerated by most patients. Here, we present a case of severe postural respiratory insufficiency following the performance of an interscalene block, in a patient with unrecognized contralateral diaphragmatic eventration.

Case presentation:
A 53-year-old male with a history of a laparotomy following a motor vehicle accident some years previously, was scheduled to undergo arthroscopic repair of his right rotator cuff. The patient was administered an ultrasound-guided interscalene brachial plexus block for post-operative pain control. The patient remained asymptomatic following the placement of the block while he was in the sitting up position. When he was laid supine for the induction of general anesthesia, he developed severe respiratory insufficiency. The surgery was cancelled. Subsequent chest x-ray and CT scan imaging revealed diaphragmatic eventration on the contralateral side.

Unrecognized pathology of the contralateral lung can lead to severe respiratory insufficiency following the placement of an interscalene block....