title: Contralateral local anesthetic spread from an outpatient interscalene catheter.
abstract: OBJECTIVE
  Ambulatory continuous infusions have been associated with improved analgesia and few serious complications. This report describes an unusual case of a patient with a continuous interscalene nerve block who developed a contralateral upper extremity sensory block. The complication did not occur until postoperative day two while the patient was at home.
  
  
  METHODS
  A 56-yr-old woman had a continuous interscalene catheter placed for arthroscopic lysis of adhesions of her shoulder. The insertion needle was initially injected with 0.5% ropivacaine 25 mL (1:400,000 epinephrine), producing a unilateral interscalene block. Postoperatively, the patient was started on a continuous interscalene infusion of 0.2% ropivacaine at 8 mL·hr(-1) via a disposable infusion pump. The next day, the patient had a unilateral brachial plexus block and an associated Horner's syndrome and was discharged home with the infusion. On the morning of the second postoperative day, the patient developed ipsilateral and contralateral Horner's syndrome with associated numbness in both shoulders. The catheter was removed and symptoms resolved four hours later.
  
  
  CONCLUSIONS
  Ambulatory continuous infusions are typically associated with few serious complications and a favourable safety profile. This case demonstrates that unexpected complications can still occur even after days of normal operation. Based on our previous experience, we believe this to be a rare but potentially serious event that requires awareness by those discharging patients with continuous infusions of local anesthetics.
authors.affiliation: Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC 27710, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Dooley
authors.forename: Mitchell
authors.initials: M
authors.lastname: Fingerman
authors.forename: Steve
authors.initials: S
authors.lastname: Melton
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Klein
mesh_terms: D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects*; D001917:Brachial Plexus; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D006801:Humans; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects* / Q000379:methods; D010045:Outpatients; D011183:Postoperative Complications / Q000139:chemically induced; D000077212:Ropivacaine; D013997:Time Factors
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine