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Local anesthetic-induced central nervous system toxicity during interscalene brachial plexus block: a case series study of three patients

  • Local anesthetics are commonly administered by nuchal infiltration to provide a temporary interscalene brachial plexus block (ISB) in a surgical setting. Although less commonly reported, local anesthetics can induce central nervous system toxicity. In this case study, we present three patients with acute central nervous system toxicity induced by local anesthetics applied during ISB with emphasis on neurological symptoms, key neuroradiological findings and functional outcome. Medical history, clinical and imaging findings, and outcome of three patients with local anesthetic-induced toxic left hemisphere syndrome during left ISB were analyzed. All patients were admitted to our neurological intensive care unit between November 2016 and September 2019. All three patients presented in poor clinical condition with impaired consciousness and left hemisphere syndrome. Electroencephalography revealed slow wave activity in the affected hemisphere of all patients. Seizure activity with progression to status epilepticus was observed in one patient. In two out of three patients, cortical FLAIR hyperintensities and restricted diffusion in the territory of the left internal carotid artery were observed in magnetic resonance imaging. Assessment of neurological severity scores revealed spontaneous partial reversibility of neurological symptoms. Local anesthetic-induced CNS toxicity during ISB can lead to severe neurological impairment and anatomically variable cerebral lesions.

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Author:Daniel SpitzerORCiD, Katharina Johanna Wenger-AlakmehORCiDGND, Vanessa NeefORCiDGND, Iris DivéGND, Martin A. Schaller-PauleORCiDGND, Kolja JahnkeORCiDGND, Christian KellORCiDGND, Christian FörchORCiDGND, Michael Christian BurgerORCiDGND
URN:urn:nbn:de:hebis:30:3-624772
DOI:https://doi.org/10.3390/jcm10051013
ISSN:2077-0383
Parent Title (English):Journal of Clinical Medicine
Publisher:MDPI
Place of publication:Basel
Document Type:Article
Language:English
Date of Publication (online):2021/03/02
Date of first Publication:2021/03/02
Publishing Institution:Universitätsbibliothek Johann Christian Senckenberg
Release Date:2021/09/06
Tag:CNS toxicity; interscalene brachial plexus block; local anesthetic; neurological outcome; toxic hemisphere syndrome
Volume:10
Issue:5, art. 1013
Page Number:13
First Page:1
Last Page:13
HeBIS-PPN:487684702
Institutes:Medizin / Medizin
Dewey Decimal Classification:6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit
Sammlungen:Universitätspublikationen
Licence (German):License LogoCreative Commons - Namensnennung 4.0