Upper extremity block: complications for specific site of injection

Which of the following statements regarding potential complications related to blocks of the brachial plexus is FALSE?

A. Although the amount of 0.75% ropivacaine via a catheter required to perform a successful ultrasound-guided interscalene block has been determined to be approximately 7 ml, we still lack the ability to predict or guarantee against phrenic nerve blockade.
B. Pneumothorax and phrenic nerve paresis have been reported as complications of infraclavicular brachial plexus blockade.
C. Complications of interscalene block include total spinal anesthesia, quadriplegia, and death.
D. Axillary brachial plexus block includes the risk of pneumothorax
E. The path of the transverse cervical artery, from the thyrocervical trunk, may interfere with supraclavicular brachial plexus block in patients.

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Correct Answer: D

Explanation:

In a dose-finding study, it is estimated that the ED95 for adequate anesthesia following shoulder surgery was 7 ml of 0.75% ropivacaine administered via an interscalene catheter. Pneumothorax and phrenic nerve palsy, although rare, have been reported following infraclavicular brachial plexus blockade. Unfortunately, severe complications have occurred following interscalene blockade, including death after a catheter was placed accidentally through the dura. The transverse cervical artery may impede the intended needle path to the brachial plexus above the clavicle. There has not been a published report of a pneumothorax following axillary nerve blockade.

References:

Dullenkopf A et al. Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block. Reg Anesth Pain Med 2004;29:110-114.

Vandepitte C et al. Effective volume of ropivacaine 0.75% through a catheter required for interscalene brachial plexus blockade. Anesthesiology 2013;118;863-7.

Benumof JL. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000;93:1541-44.

Yanovski B et al. Catastrophic complication of an interscalene catheter for continuous peripheral nerve block analgesia. Anaesthesia 2012;67-1166-1169.

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