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Pneumothorax following serratus anterior plane block

Pneumothorax following serratus anterior plane block Serratus anterior plane blocks may provide analgesia for rib fractures, thoracic surgery and breast surgery. There remains uncertainty regarding the location of injection, be it superficial or deep to the serratus anterior muscle. We describe the case of a 63‐year‐old ASA physical status 3 woman undergoing a wire‐guided wide local excision of a right breast lump. A modified right serratus anterior plane block was performed under ultrasound guidance, injecting 20 ml of bupivacaine 0.25% deep to the serratus anterior muscle. No immediate complications were noted. Intra‐operatively the patient developed arterial desaturation associated with high airway pressures. A subsequent chest radiograph in the post‐anaesthetic care unit demonstrated a large right‐sided pneumothorax which was treated with immediate needle decompression and chest drain insertion. This is the first case of pneumothorax reported from this approach to serratus anterior plane blockade and serves as a reminder of a potential serious complication. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Pneumothorax following serratus anterior plane block

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Publisher
Wiley
Copyright
2020 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12034
Publisher site
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Abstract

Serratus anterior plane blocks may provide analgesia for rib fractures, thoracic surgery and breast surgery. There remains uncertainty regarding the location of injection, be it superficial or deep to the serratus anterior muscle. We describe the case of a 63‐year‐old ASA physical status 3 woman undergoing a wire‐guided wide local excision of a right breast lump. A modified right serratus anterior plane block was performed under ultrasound guidance, injecting 20 ml of bupivacaine 0.25% deep to the serratus anterior muscle. No immediate complications were noted. Intra‐operatively the patient developed arterial desaturation associated with high airway pressures. A subsequent chest radiograph in the post‐anaesthetic care unit demonstrated a large right‐sided pneumothorax which was treated with immediate needle decompression and chest drain insertion. This is the first case of pneumothorax reported from this approach to serratus anterior plane blockade and serves as a reminder of a potential serious complication.

Journal

Anaesthesia Reports – Wiley

Published: Jan 1, 2020

Keywords: education and training; peri‐operative medicine; regional anaesthesia

References

  • Serratus plane block: a novel ultrasound‐guided thoracic wall nerve block
    Blanco, R; Parras, T; McDonnell, JG; Prats‐Galino, A
  • Ultrasound‐guided serratus anterior plane block versus thoracic epidural analgesia for thoracotomy pain
    Khalil, AE; Abdallah, NM; Bashandy, GM; Kaddah, TAH
  • Serratus anterior plane block for multiple rib fractures
    Kunhabdulla, Poolayullathil; Kunhabdulla, NP; Agarwal, AA
  • Analgesic combined lateral and anterior cutaneous branches of the intercostal nerves ultrasound block in ambulatory breast surgery
    Fajardo, M; García, FJ; López, S; Diéguez, P; Alfaro, P
  • An anatomical evaluation of the serratus anterior plane block
    Mayes, J; Davison, E; Panahi, P