title: Ipsilateral brachial plexus block and hemidiaphragmatic paresis as adverse effect of a high thoracic paravertebral block.
abstract: BACKGROUND
  Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate.
  
  
  METHODS
  We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral block at T2-3. One patient also developed an ipsilateral hemidiaphragmatic paresis, an adverse effect that has not been reported before. Subsequent radiologic examination revealed a limited thoracic cephalad spread of the radiopaque dye and a laterally ascending spread from the thoracic paravertebral space toward and around the brachial plexus. We offer potential explanations for these phenomena.
  
  
  CONCLUSIONS
  Brachial plexus block can occur by a route parallel to a nerve connecting the second intercostal nerve and T1 nerve, that is, Kuntz nerve. The hemidiaphragmatic paresis was attributed to the ascending spread of local anesthetic toward the area where the phrenic nerve bypasses the subclavian artery and vein.
authors.affiliation: Anesthesiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. s.renes@anes.umcn.nl
authors.forename: Steven H
authors.initials: SH
authors.lastname: Renes
authors.forename: Geert J
authors.initials: GJ
authors.lastname: van Geffen
authors.forename: Miranda M
authors.initials: MM
authors.lastname: Snoeren
authors.forename: Matthieu J
authors.initials: MJ
authors.lastname: Gielen
authors.forename: Gerbrand J
authors.initials: GJ
authors.lastname: Groen
mesh_terms: D000328:Adult; D001917:Brachial Plexus / Q000000981:diagnostic imaging* / Q000187:drug effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects*; D011859:Radiography; D012133:Respiratory Paralysis / Q000000981:diagnostic imaging* / Q000209:etiology*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging*