Complication of interscalene block in pregnant woman with achondroplasia: A case report

Interscalene blocks are commonly used in surgeries that involve the clavicle, shoulder, and upper arm. There is a lack of literature that explains the best anesthesia techniques for pregnant women with achondroplasia. A 28-year-old achondroplastic woman (35 kg, 110 cm), 30-31 weeks of pregnancy, planned elective ORIF of the right distal radius. The decision chosen after the preoperative evaluation was a peripheral nerve block anesthetic technique. In the operating room, routine non-invasive monitoring was established, and an interscalene block was performed using a 50 mm stimuplex needle under ultrasound guidance (golf-stick probe). A maneuver was performed towards the brachial plexus. After arriving at the C6-C7 sheath, twitching occurred in the bicep and the deltoid muscle area; 1 ml of 0,18% ropivacaine was injected to determine the spread of the local anesthetic, and then 9 ml was slowly added. Thereafter, the assistant evaluated the target block area and found that it was starting to feel numb but still felt painful. Then the needle is directed to the C5-C6 sheath, and 10 ml of ropivacaine is slowly injected. The patient feels short of breath, the respiratory rate increases and the patient becomes restless. the anesthetic technique was converted to general anesthesia. The operation took 4 hours and 30 minutes without additional opioid drugs. After surgery is completed, weaning from anesthesia begins. It was decided to extubate, but after extubation, the patient’s respiratory effort increased with obstruction and desaturation. Reintubation was carried out and the patient was treated in the ICU.