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Severe pneumothorax after intercostal nerve blockade. A case report

A Holzer1, S Kapral, K Hellwagner

  • 1Department of Anesthesiology and General Intensive Care, University of Vienna, Austria.

Acta Anaesthesiologica Scandinavica
|November 11, 1998
PubMed
Summary

Severe pneumothorax occurred during intercostal nerve blockade, even with appropriate technique. Patients with lung disease require extra caution, and dorsal approaches may reduce pneumothorax risk.

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Area of Science:

  • Anesthesiology
  • Thoracic Surgery
  • Radiotherapy

Background:

  • Intercostal nerve blockade is a common regional anesthetic technique.
  • While generally safe, severe complications like pneumothorax can occur.
  • This case highlights a rare but serious adverse event during the procedure.

Observation:

  • A 57-year-old female patient developed severe pneumothorax after intercostal nerve blockade (nerves 3-8) for breast radiotherapy.
  • The patient had pre-existing calcified lung foci from tuberculosis.
  • Symptoms included dyspnea, panic, and chest pain, necessitating chest tube placement.

Findings:

  • A severe pneumothorax was diagnosed and successfully treated with a chest tube.
  • The complication arose despite the use of an appropriate anesthetic technique.

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  • The patient's underlying lung condition may have contributed to the adverse event.

    • Implications:

    • Extra caution is advised for patients with chronic lung disease undergoing intercostal nerve blockade.
    • A dorsal angulation approach in lateral or prone positions may lower pneumothorax risk.
    • This case underscores the importance of patient selection and procedural positioning in regional anesthesia.