372 posters, 1 audios, 13 topics, 29 sessions, 1,035 authors, 449 institutions

51st Annual Regional Anesthesiology and Acute Pain Medicine Meeting

April 16 - 18, 2026 | Phoenix, Arizona

2316064

Prolonged Dyspnea and Voice Hoarseness Months After Interscalene Catheter Removal

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Poster Presenter

Viet Scott Nguyen

Authors

Viet Scott Nguyen, Andres Giraldo, Taizoon Dhoon, Trevor Whitwhell

Affiliations

University of California Irvine Health

Part of Topic

Medically Challenging Cases

Prolonged Dyspnea and Voice Hoarseness Months After Interscalene Catheter Removal

Background

Phrenic nerve palsy and voice hoarseness are common complications ofinterscalene blockades, but usually resolve when the local anestheticdissipates
Although the incidence of complications is as low as 5.24% [1], thesesymptoms could persist much longer after single shot blocks and removalof interscalene catheters in 0.048% of cases [2]
This case presentation describes the symptomology and workup forpersistent dyspnea and voice hoarseness months after removal of aninterscalene catheter.

Case Presentation

A 62 year old female with a history of mild asthma presented for rightshoulder arthroplasty; an interscalene catheter was placed for postoppain control
Pain was well controlled on postop day zero, the patient reporteddyspnea requiring supplemental oxygen. CXR revealed right sidedelevated hemidiaphragm (Fig 1)
The catheter was removed five days after initial placement
The patient reported residual dyspnea and hoarseness of voice a monthafter catheter removal
Thoracic surgery was consulted to perform a “sniff” test which yieldednormal findings and resolution of right elevated hemidiaphragm
ENT was then consulted who performed direct vocal cord visualizationwith normal findings
Pulmonology was consulted and placed the patient on respiratoryinhalers and ordered pulmonary function testing and immune testing(which were unremarkable)
Due to negative workup, no active treatment was done for the patientother than follow up
Respiratory function and voice returned to near baseline approximatelysix months after interscalene catheter removal

Discussion

Persistent phrenic nerve palsy and voice hoarseness followinginterscalene catheters are rare
Workup for phrenic nerve palsy includes chest x-ray, ultrasound,“sniff” fluoroscopy test, pulmonary function tests, and phrenic nervestimulation tests (Figure 2); management is supportive
For voice hoarseness, direct visualization with ENT is first-line [3],and a CT neck is used to visualize the recurrent laryngeal nerve(Figure 2). Management is primarily voice therapy with followup.
To date the etiology of prolonged symptoms is unelucidated
Highly irregular to have symptoms in the setting of normal workup
The cause of the residual symptoms is likely multifactorial, not justsimply due to side effects from the interscalene catheter

Conclusion

Prolonged dyspnea and voice hoarseness are rare, but possible sideeffects after interscalene blocks
For each of the above symptoms, there are different workups includingthe diagnostic imaging and confirmatory testing
In the setting of normal testing, etiology of prolonged symptoms arelikely multifactorial, and may not be solely secondary to interscaleneblockade

References

1. Holbrook HS, Parker BR. Peripheral Nerve Injury Following Interscalene Blocks: A Systematic Review to Guide Orthopedic Surgeons. Orthopedics. 2018;41(5):e598-e606. doi:10.3928/01477447-20180815-04

2. Chiaghana CO, Awoniyi CA. Delayed onset and long-lasting hemidiaphragmatic paralysis and cranial nerve deficit after interscalene nerve block for rotator cuff repair in beach chair position. J Clin Anesth. 2016;34:571-576. doi:10.1016/j.jclinane.2016.06.026

3. Stachler RJ, Francis DO, Schwartz SR, et al. Clinical Practice Guideline: Hoarseness (Dysphonia) (Update) Executive Summary. Otolaryngology–Head and Neck Surgery. 2018; 158: 409-426. https://doi.org/10.1177/0194599817751031