Pourfour Du Petit syndrome after interscalene block
A 24-year-old male with fracture upper third shaft of left humerus was posted for open reduction and internal fixation. Patient had an insignificant post-anesthetic exposure for left inguinohernioplasty under spinal anesthesia. Patient was explained about the option of regional anesthesia for the above surgery and also about the possible complications. He agreed for the brachial plexus block. Patient was 152 cm tall, weighed 70 kg with no coexisting disease, and had normal physical examination and routine investigation.\nA left brachial plexus block was performed under aseptic precautions by interscalene approach using a 22-guage, 2-inch insulated needle with extension tube assembly (Stimuplex®, B Braun, Melsungen AG, 34209, Melsungen, Germany) after localizing the plexus with the help of the nerve stimulator by eliciting motor response at shoulder and upper arm at 0.5 mA. With all standard monitors, 40 ml of local anesthetic solution containing 200 mg of lignocaine with 50 μg adrenaline and 50 mg of bupivacaine was injected slowly over 5 min. Adequate sensory and motor block was achieved. But within 10 min after injection of local anesthetic solution, patient complained of increased sweating in the face and diminished vision in the left eye. On examination, sweating was confined to the left half of the face with widened palpebral fissure of the left eye and the left pupil was dilated in comparison to the right pupil (4 mm/2 mm). Patient was reassured and the surgery was completed successfully. These symptoms resolved when the plexus functions returned to normal.