Phrenic Nerve Block for Management of Post-Thoracic Outlet Decompression Cough: A Case Report and Literature Review
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…
2024 2,802 reads 2 citations
Case Reports
Phrenic Nerve Block for Management of Post-Thoracic Outlet Decompression Cough: A Case Report and Literature Review
IntroductionThoracic 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 presentationA 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 reviewThe 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.
ConclusionA 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.
Keywords Cough Nerve block Postoperative complications Thoracic outlet syndrome Management All subjects
Barw Medical Journal. 2024;3(1)