Lower lobe collapse during continuous interscalene brachial plexus local anesthesia at home.

OBJECTIVES: We report a case of pulmonary left lower lobe collapse following an interscalene local anesthetic infusion administered at home. This case highlights the need for patient education and postoperative communication. CASE REPORT: report A 52-year-old male patient presented for a rotator cuff repair. He was a chronic tobacco abuser with a history of occasional chest pain of unexplained cause. An interscalene catheter was placed preoperatively and surgery was performed under a combination of an interscalene block and a general anesthetic. An infusion of 0.2% ropivacaine was started via the interscalene catheter postoperatively and continued at home following his discharge from the hospital on the third postoperative day. Within 24 hours of discharge, he was readmitted to the hospital after complaining of chest pain and dyspnea. The patient was seen in the emergency department by nonanesthesiologists who were not familiar with the potential for interscalene blocks to cause diaphragmatic paresis. CONCLUSIONS: Good communication must be maintained with the patient at all times. Doctors from other specialties may be unaware of the potential complications of an interscalene block.

An alternative portal for scapulothoracic arthroscopy.

Access to the superior angle of the scapula during scapulothoracic arthroscopy with current standard portals can be difficult. A safe, effective alternative portal for scapulothoracic arthroscopy, located superior to the scapula, is described, which enables easier resection of the superomedial angle for treatment of the snapping scapula.