Why a pneumothorax?

Just saying....

The rate of major complications when interscalene nerve blocks (ISBs) are used in shoulder surgery is well under 1%, according to a recently published literature review. Nevertheless, a survey conducted by the authors showed that about a quarter of experienced shoulder surgeons would not elect an ISB for themselves.

The authors searched PubMed for all prospective and retrospective studies that considered patient complications from use of ISBs, specifically in shoulder surgery, with 50 blocks performed per study. They found 13 eligible studies that, when combined, included 6,243 ISBs, of which 15% included a perineural catheter as well. Altogether, 69% of the blocks were performed in a university hospital or university ambulatory center.

According to the authors, there is no well accepted definition of “complication” with regard to ISBs. They defined a major complication as:

• Death
• Risk to the patient’s life (pneumothorax, myocardial infarction, stroke, seizure, or systemic toxicity)
• Nerve injury that had not resolved by study end

The rate of major complications when interscalene nerve blocks (ISBs) are used in shoulder surgery is well under 1%, according to a recently published literature review. Nevertheless, a survey conducted by the authors showed that about a quarter of experienced shoulder surgeons would not elect an ISB for themselves.



 The interscalene nerve block is typically used for shoulder, clavicle, or upper arm surgeries because it covers higher up on the shoulder. The disadvantage is that patients will experience phrenic nerve blockade resulting in diaphragmatic paralysis. In most patients, this does not significantly compromise lung function. However, patients with underlying lung disease are at higher risk for respiratory compromise and should be monitored closely. The risk of pneumothorax is present, but minimal.

Supraclavicular

Supraclavicular nerve block is ideal for procedures of the upper arm, from the mid‐humeral level down to the hand. The area covered is similar to the interscalene block, but does not cover the upper part of the shoulder as well. It has a rapid onset, with a dense and predictable level of pain control. There is a slightly higher risk of pneumothorax than the interscalene nerve block. Signs and symptoms of a large pneumothorax include sudden cough and shortness of breath. In addition, approximately 50% of patients will have diaphragmatic hemiparesis.

Thanks to l'autre belle Fille for leading me to the right Google search.