Severe pneumothorax after intercostal nerve blockade. A case report

Intercostal nerve blockade is recognized as an efficient and safe regional anesthetic technique. Although an appropriate technique was applied, we report a severe pneumothorax associated with this type of regional anesthesia.

A 57-year-old female patient underwent block of intercostal nerves 3 to 8 for interstitial radiotherapy of the left breast in the sitting position. Calcified residual foci in the right upper lobe from a previous primary infection of tuberculosis were diagnosed by preoperative x-ray. After completion of the blocks in the midline of the axilla, the patient complained of pain between the scapulas, developed severe dyspnea and panic, and felt as if her life was in jeopardy. A severe pneumothorax was diagnosed and a chest tube was placed. After the application of the chest tube, the patient recovered quickly.

Extra caution should be used in applying this procedure to patients with underlying chronic lung disease, especially on the opposite side. Our case demonstrates that in all patients undergoing intercostal nerve blockade preference should be given to the approach at the dorsal angulation of the rib in the lateral or prone position due to its lower risk of pneumothorax.