Question of the Month - January 2020 - Society for Pediatric Pain Medicine

Petrus Paulus Steyn, MD
Fellow, Department of Anesthesiology and Critical Care Medicine
Children's Hospital of Philadelphia

A 14-year-old basketball player presents for a shoulder arthroscopy and a Bankart repair of his right shoulder. In the preoperative holding area, you inform the patient and his mother that you plan to have him under general anesthesia for this procedure and that you want to perform an ultrasound guided single-shot interscalene block after he is asleep for postoperative pain management. After describing the procedure, its potential minor and major complications and alternatives, you ask the patient and his mother if they have any questions.

The mother notes that her son has an upcoming school dance (in a month) and wants to know:

> What the likelihood is that ‘this eyelid droop’ will happen?
> If it does happen how long it will take to go away?
> Is it ever permanent?
> Can it happen on both sides?

What will you tell her?

A) The Incidence of Horner’s is 100%, it typically takes a month to disappear, it is often permanent and happens on both sides 50% of the time.

B) The incidence of Horner’s is 20-60%, it is typically transient and will disappear as the local anesthetic wears off. Some case reports do describe delayed Horner’s syndrome and that if this occurs it may take up to a year to completely resolve.

C) The incidence of Horner’s is 5% and it takes 1-2 years to resolve and can happens on both sides of the face.

D) You are not sure of the exact percentage but as this is likely side effect after the interscalene block you recommend that they do not perform an interscalene block if the mother is concerned about Horner’s syndrome.

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Question of the Month – January 2020

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