title: Pneumothorax following infraclavicular brachial plexus block for hand surgery.
abstract: The infraclavicular brachial plexus block is a routinely used anesthesia technique for orthopedic hand, wrist, and arm surgeries. Although the pulmonary anatomy surrounding the brachial plexus would suggest a theoretical potential for pneumothorax development during infraclavicular brachial plexus blockade, this complication is rarely reported in the literature. We report two occurrences of pneumothorax development following routine infraclavicular brachial plexus blockade performed by physicians at an academic training institution with technical experience. Both patients were healthy adult males with a normal body habitus undergoing elective upper extremity surgical intervention. They presented to the emergency department on postoperative days 1 and 2 with shortness of breath and chest pain. Despite different clinical management strategies for each patient, including conservative physical activity with inspirational spirometry compared to thoracic decompression, both patients' pneumothoraces resolved with no apparent sequelae. This article describes the clinical benefits of infraclavicular brachial plexus blockade versus general anesthesia during elective outpatient surgeries. The development of symptomatic pneumothoraces in 2 healthy adult patients stresses the importance of careful patient assessment pre- and postoperatively. Possible preventative strategies to avoid pneumothorax complications during infraclavicular brachial plexus blockade are discussed. This case report indicates there is a risk of iatrogenic injury during infraclavicular brachial plexus blockade. This information could be valuable in determining anesthesia modalities used for orthopedic upper extremity surgeries in patient populations with problematic follow-up or limited access to health care.
authors.affiliation: Department of Orthopedic Surgery, University of California San Diego Medical Center, San Diego, California 92103, USA.
authors.forename: Hugo B
authors.initials: HB
authors.lastname: Sanchez
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
authors.forename: Reid
authors.initials: R
authors.lastname: Abrams
authors.forename: Matthew
authors.initials: M
authors.lastname: Meunier
mesh_terms: D001917:Brachial Plexus; D006225:Hand / Q000601:surgery*; D006801:Humans; D007267:Injections / Q000009:adverse effects*; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D011030:Pneumothorax / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000209:etiology* / Q000628:therapy; D055815:Young Adult