The second patient was unable to be extubated for one hour due to, presumably, phrenic nerve block. After extubation, her chest radiograph revealed a unilateral diaphragmatic paralysis. Daily chest x-ray showed persistent paralysis for three days. This resolved by the fourth day and she was discharged to home. One common denominator in all three of these cases was the patients weight.
Landmarks tend to be more difficult to locate in the obese patient.
The use of interscalene block has brought about important clinical implications regarding patient safety, patient satisfaction, patient education, analgesic requirements, and recovery time. A patient satisfaction questionnaire was developed and used for follow-up evaluation and showed that patients did not experience undue discomfort during the placement of an interscalene block. Additionally, patients reported a delayed frequency to the first dose of analgesic medication following discharge, which ranged from 4-12 hours. The patients have minimal pain upon awakening, and therefore have a delayed need for postoperative analgesics following interscalene block. The surgeons had the impression that their patients are more likely to have a positive psycho-emotional response to their experience and begin the process of coping with their recovery and rehabilitation more effectively because of the comfortable postoperative period provided by interscalene block.