Double trouble: hoarseness and Horner’s after supraclavicular brachial plexus block

Supraclavicular brachial plexus block is a popular procedure for surgeries of the upper limb. Although separate instances of Horner’s syndrome and recurrent laryngeal nerve palsies have been previously reported with this approach and one combined incidence has been reported following an interscalene approach, a combined incidence following a supraclavicular approach has not been previously documented. A 21-year-old male patient, who presented with a laceration and suspected vascular injury over his right palm, had a supraclavicular block placed with a tourniquet inflated to minimise bleeding. He developed Horner’s syndrome and hoarseness of voice in the immediate postoperative period. There was complete resolution of symptoms after eight hours. The presence of an external force in the form of a tourniquet may influence the spread of the local anaesthetic due to compressive effects on the axillary fascial sheath. However, further studies are required to prove this.Keywords: combined incidence, Horner’s syndrome, recurrent laryngeal nerve palsy, supraclavicular brachial plexus bloc

Differentiating the headache of cerebral venous thrombosis from post-dural puncture: A headache for anaesthesiologists

Cerebral venous thrombosis (CVT) is a rare complication of lumbar puncture. Occasionally, the clinical picture of CVT may mimic post-dural puncture headache (PDPH) resulting in delayed diagnosis. A case of PDPH progressing to CVT is presented and the pathophysiology, diagnostic challenges and management options discussed in this article