Interscalene block side effects

Advanced, Generic Clinical Sciences, Regional

The Bezold-Jarisch reflex results in unmyelinated vagal afferent stimulation in response to noxious ventricular stimuli (chemical or mechanical), leading to the triad of hypotension, bradycardia, and coronary vasodilation (mediated via increased parasympathetic tone as well as by ANP and BNP). In the setting of shoulder surgery, it is postulated that the combination of increased levels of circulating epinephrine combined with the sitting position may irritate the left ventricle , leading to the massive parasympathetic outflow that accompanies the Bezold-Jarisch reflex. It is also thought that perioperative beta blockade may increase the incidence of this dangerous reflex . The Bezold-Jarish reflex (bradycardia and hypotension following sudden loss of cardiac stimulation) occurs in 15-30% of patients and can be treated by volume, atropine, and ephedrine.

  • Diaphragmatic hemiparesis from ipsilateral phrenic nerve block (100% incidence, 25% reduction in pulmonary function)
  • Pneumothorax
  • Permanent neurologic injury
  • Blockade of vagus, recurrent laryngeal, and cervical sympathetic nerves (Horner’s syndrome )
  • Epidural or subarachnoid injection
  • Vertebral artery injection
  • Severe hypotension and bradycardia (Bezold-Jarisch reflex )

79%

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2019

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85%

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2015

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75%

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2011

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