Barw Barw Medical Journal 2960-1959 2024 12 20 Phrenic Nerve Block for Management of Post-Thoracic Outlet Decompression Cough: A Case Report and Literature Review 10.58742/bmj.v2i4.149 eng Fahmi H. Kakamad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. fahmi.hussein@univsul.edu.iq Soran H. Tahir College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. soran.tahir@gmail.com Nsren S. Sabr Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. nsren.sabr@gmail.com Rezheen J. Rashid Department of Radiology, Hiwa Hospital, Sulaymaniyah, Iraq. rezheen.rashid@gmail.com Saywan Kakarash Asaad College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Iraq. saiwan.asaad@gmail.com Abdullah K. Ghafour Department of Orthopedic, Shahid Peshraw Hospital, Chamchamal, Iraq. abdullah.ghafour@gmail.com Pavel Mustafa Kareem Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. pavel.kareem@gmail.com Dilan S. Hiwa Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. dilan.sarmad.hiwa@gmail.com Mohammed Subhan Mohammed Research Center, University of Halabja, Halabja, Iraq. mohammed111@gmail.com Abdullah A. Qadir Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. abdullah.qadir@gmail.com Fakher Abdullah Kscien Organization for Scientific Research (Middle East office), Hamid Street, Azadi Mall, Sulaymaniyah, Iraq. fakherabdullah1976@gmail.com Sarhang Sedeeq Abdalla Scientific Affairs Department, Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Iraq. sarhang.abdullah@gmail.com 2024 11 10 Introduction Thoracic outlet syndrome is a group of disorders arising from compressive forces on the neurovascular bundle in that region due to different etiologies. This study aims to present a case with an intractable cough as a complication of the surgery and its management. Case presentation A 41-year-old woman had a 15-year history of bilateral upper limb pain and numbness. The pain worsened over the last two months. Tests and imaging confirmed thoracic outlet syndrome. Physiotherapy had no effect. She underwent thoracic outlet decompression (TOD) under general anesthesia via a supraclavicular incision. Post-surgery, she developed uncontrollable cough that didn't respond to medication. Two days after the operation, a bupivacaine (5%) injection near the phrenic nerve resolved the cough. Literature review The literature review identified several cases of TOD complications, including right phrenic nerve paralysis resolving in 3-6 months, unilateral right diaphragm dysfunction, and lung herniation successfully treated with thoracoscopic reduction. These cases underscore the diverse presentations and outcomes of TOD complications, highlighting the importance of early diagnosis and tailored management strategies. Conclusion A possible complication of surgical decompression for thoracic outlet syndrome is an intractable cough that can be relieved by the injection of local anesthesia into the area of the phrenic nerve.