Incidence of clinically symptomatic pneumothorax in ultrasound‐guided infraclavicular and supraclavicular brachial plexus block

Abstract

SummaryThe use of periclavicular brachial plexus block as regional anaesthesia for surgical procedures on the upper extremity is common. However, the proximity of the pleura results in a risk of pneumothorax. Without ultrasound monitoring, the pneumothorax risk has been reported to be as high as 6.1%. We conducted a prospective, observational study to examine the risk of pneumothorax in 6366 ultrasound-guided periclavicular plexus blocks. All patients with a clinically manifest and radiologically confirmed pneumothorax were analysed. Clinically symptomatic pneumothorax occurred in four patients (0.06%; 95% CI 0.001-0.124), in three of them after a two-day latency period. Ultrasound guidance does therefore appear to reduce the risk of pneumothorax. Although all of the anaesthesiologists involved in the complications had previously performed fewer than 20 blocks, we are not able to confirm that a block experience ≤ 20 is a significant risk factor. Faulty image-setting, inability to obtain a view of the needle tip and inadequate supervision are likely to be important risk factors.

Effects of Dexmedetomidine Versus Ketorolac as Local Anesthetic Adjuvants on the Onset and Duration of Infraclavicular Brachial Plexus Block

“…We recommend further studies focusing in adverse effects of perineural injection of these drugs. We saw no immediate side effect in this study, but intravascular injection of local anesthetics and pneumothorax were reported in other studies (20, 21). …”

A review of the anatomy and a step-by-step visual guide to performing an ultrasound-guided supraclavicular brachial plexus block

“…The reported incidence of pneumothorax without ultrasound guidance ranges between 0.5-6% whereas with the aid of ultrasound guidance the incidence is 1%. 13,14,15 Other complications that may occur include injury to the recurrent laryngeal nerve resulting in a hoarse voice (a reported incidence of 1%), phrenic nerve injury resulting in hemidiaphragmatic paresis (a reported incidence of 33%), and vascular puncture (a reported incidence of 0.4%). 13,14,15 Horner's syndrome has also been described and results from paralysis of the ipsilateral sympathetic cervical chain caused by drugs, surgery or local compression (a reported incidence of 1%).…”

“…13,14,15 Other complications that may occur include injury to the recurrent laryngeal nerve resulting in a hoarse voice (a reported incidence of 1%), phrenic nerve injury resulting in hemidiaphragmatic paresis (a reported incidence of 33%), and vascular puncture (a reported incidence of 0.4%). 13,14,15 Horner's syndrome has also been described and results from paralysis of the ipsilateral sympathetic cervical chain caused by drugs, surgery or local compression (a reported incidence of 1%). 13,14,15 The latter can be caused by the injection of large volumes of local anaesthetic or the atypical proximal migration of the solution above the clavicle toward the interscalene area.…”

“…13,14,15 Horner's syndrome has also been described and results from paralysis of the ipsilateral sympathetic cervical chain caused by drugs, surgery or local compression (a reported incidence of 1%). 13,14,15 The latter can be caused by the injection of large volumes of local anaesthetic or the atypical proximal migration of the solution above the clavicle toward the interscalene area. 15 Horner's syndrome is classified by a triad of symptoms including miosis, a condition in which there is excessive constriction of the pupil; ptosis or drooping of the upper eyelid; and anhidrosis -the absence of perspiration or failure of the sweat glands.…”

“…13,14,15 The latter can be caused by the injection of large volumes of local anaesthetic or the atypical proximal migration of the solution above the clavicle toward the interscalene area. 15 Horner's syndrome is classified by a triad of symptoms including miosis, a condition in which there is excessive constriction of the pupil; ptosis or drooping of the upper eyelid; and anhidrosis -the absence of perspiration or failure of the sweat glands. 16 The rate of complications is also related to the experience of the anaesthetist.…”