Prolonged Horner’s syndrome after intraoperative interscalene block

Abstract

Interscalene blockade (ISB) is frequently used for intraoperative anesthesia and postoperative analgesia for surgical procedures involving the shoulder and upper extremity. While generally devoid of adverse effects, inadvertent damage to or spread of the local anesthetic agent to surrounding neurovascular structures in the neck may result in unintended consequences. We present the report of a 21-year-old male, who underwent diagnostic shoulder arthroscopy and labral repair. To supplement general anesthesia and provide postoperative pain, an ISB was placed. The immediate postoperative course was uneventful and the patient was discharged home. A few hours later, the patient complained of numbness over his face that progressed to Horner’s syndrome with prolonged ptosis lasting for 6 months. The potential etiologies of Horner’s syndrome following ISB are presented, previous reports of this complication reviewed, and treatment strategies discussed.