Document resource
Background and Aims Supraclavicular brachial plexus blocks are commonly used for upper limb surgeries but carry the risk of phrenic block due to cephalad spread of local anesthetics, leading to diaphragmatic paresis and respiratory depression. Doxapram, a respiratory stimulant, is traditionally used for opioid-induced respiratory depression, but its role in reversing phrenic nerve-related respiratory compromise remains underrecognized. We present a case where doxapram successfully reversed respiratory depression following a supraclavicular block.Methods A 68-year-old male underwent elective thumb surgery under general anesthesia with a supraclavicular brachial plexus block using levobupivacaine 0.5% (20 milliliters) under ultrasound guidance. Postoperatively, he exhibited delayed emergence, slow respiratory rate, reduced tidal volume, mild hypoxia, and no signs of opioid overdose. Phrenic nerve involvement was suspected due to diaphragmatic paresis. Doxapram (1 milligram per kilogram intravenously) was administered, resulting in rapid improvement in respiratory effort, rate, and oxygen saturation. The patient recovered fully without invasive support.Results Phrenic nerve block occurs in 50–60% of supraclavicular blocks due to local anesthetic spread. While often subclinical, it can cause significant respiratory compromise in patients with limited reserve or residual anesthesia. Doxapram, acting on carotid chemoreceptors and central respiratory centers, effectively reversed respiratory depression in this case. Clinicians should consider phrenic nerve paresis in postoperative respiratory depression and use ultrasound-guided techniques to minimize risks.Conclusions This case highlights the importance of recognizing phrenic nerve involvement as a complication of supraclavicular blocks. Doxapram can effectively reverse respiratory depression in such scenarios, avoiding invasive support. Careful patient selection and ultrasound guidance are essential to minimize risks and improve outcomes.