Brain edema after ultrasound-guided supraclavicular block

Abstract

Supraclavicular nerve block is the most popular regional anesthesia approach for upper limb surgery. It also predispose
some complications because of the adjacent neurovascular structures such as pleura, recurrent laryngeal and phrenic nerve,
supraclavicular vessels, and spinal cord structures. The widespread use of ultrasound for peripheral nerve blocks has reduced
the incidence of these complications. We aimed to present a case of brain edema developed after ultrasound-guided supraclavicular block which was not reported in the literature before.
A 25 years old, American Society of Anesthesia (ASA) score I, male patient was admitted to our clinic to perform the
replacement of external fixator with an internal fixator. The ultrasound guidance supraclavicular nerve block was performed. After the block, we observed disorientation, blurring in consciousness, paleness, tachycardia, hypertension and
tachypnea. Upon this, we performed induction for general anesthesia and intubation. After the onset of myoclonic epileptic seizure, he was re-intubated in the recovery room. Bilateral cerebral parenchyma was edematous, the sulci were faint
and venous structures were prominent on the brain computerized tomography. Because of magnetic resonance imaging
(MRI) finding that restricted diffusion which was compatible with cortical-subcortical acute ischemia, mannitol, dexamethasone and furosamid were started as anti-edema treatment. On the third day in intensive care unit, the patient
was extubated because of improvement in consciousness and marked decrease in brain swelling on the control radiologic imaging.
It should be kept in mind that brain edema secondary to local anesthetic systemic toxicity (LAST) may develop as a
complication after brachial plexus blocks.