Interscalene block and pneumothorax

  1. Has anyone come across a patient who was given an interscalene block, who, after several minutes developed a pneumothorax? There was a case in my training hospital institution where a patient supposedly developed a pneumo, several minutes after an interscalene block.

    I was assigned to talk about the case next month for our journal club. But as I recall from when we took our class in regional anesthesia, the rate for pneumothorax after an interscalene block is 0.0%! So, could this case be the exception, or was this just coincidental?

    Any comments?

    Thanks.

    Vinny
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  2. 2 Comments

  3. by   SproutRN
    Quote from vinnysca
    Has anyone come across a patient who was given an interscalene block, who, after several minutes developed a pneumothorax? There was a case in my training hospital institution where a patient supposedly developed a pneumo, several minutes after an interscalene block.

    I was assigned to talk about the case next month for our journal club. But as I recall from when we took our class in regional anesthesia, the rate for pneumothorax after an interscalene block is 0.0%! So, could this case be the exception, or was this just coincidental?

    Any comments?

    Thanks.

    Vinny
    Vinny, I have not had this experience with any ISB blocks I have performed. I also just completed my Capstone project on interscalene blocks. There is always a risk of pneumothorax associated with this block, there is less risk with the interscalene approach because it is most proximal. I am assuming you were performing the true interscalene approach and not the supraclavicular approach. There are plenty of articles available on this topic.

    Sprout
  4. by   URgettingsleepy
    The brachial plexus at the level of C6 is only about 1-3cm deep. Basically, If you hit a lung starting at the C6 level you are way to deep. The risks of stellate ganglion block, interarterial, subarchnoid, and epidural injection are also present.
    Not to mention phrenic nerve paralysis that occurs 100% of the time. My last interscalene block the patient developed horners syndrome which occurs with greater than 30% of interscalene blocks. It makes the patient look like they had a stoke. Myosis, ptosis, and a sunken in eyeball!!

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