Respiratory Failure Following Interscalene Block for the Treatment of Shoulder Dislocation in a Patient with COVID-19

Guidelines recommend the use of regional anesthesia for patients with COVID-19, when possible. Interscalene block (ISB) is the standard care for analgesia of shoulder surgery. Hemidiaphragmatic paresis due to phrenic nerve block is expected in ISB but is usually well-compensated. We present a patient with pulmonary involvement of COVID-19 candidate for the surgery of shoulder dislocation under ISB who experienced respiratory failure after the block.

A 36-year-old female patient with COVID-19 developed a shoulder dislocation following a seizure. Relocating the joint was successfully attempted under intravenous sedation and ultrasound-guided ISB. The patient developed respiratory distress due to hemidiaphragmatic paresis after the block. She was managed using a continuous positive airway pressure (CPAP) mask for 48 hours until the pulmonary condition improved.

Anesthetists should prepare themselves to replace ISB with diaphragm-sparing blocks or apply techniques to reduce the chance of hemidiaphragmatic paresis after ISB in patients with COVID-19.