Massive hemothorax: A rare complication after supraclavicular brachial plexus block

Abstract

Plexus block is the preferred anesthesia plan for upper limb surgeries. Among the known complications, hematoma formation following the vascular trauma is often occur but this complication is frequently underreported. We present a case where a massive hemothorax developed post operatively in a patient who underwent resection of giant cell tumor of the right hand radius bone followed by arthroplasty under brachial plexus block using supraclavicular approach. This case report attempts to highlight the essence of remaining vigilant postoperatively for first initial days after brachial plexus block, especially after failed or multiple attempts. Ultrasound guided technique in combination with nerve stimulator has proven to be more reliable and safer than traditional techniques.

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy

“…All published cases of clinically significant bleeding/bruising after plexus or peripheral techniques in patients with normal hemostasis are reported in Table 20, [306][307][308][309][310][311][312][313][314][315][316][317][318] and those receiving antithrombotic therapy are reported in Table 21. 236,237,303,304,310,[321][322][323][324][325] In all patients with neurodeficits, neurologic recovery was complete within 6 to 12 months.…”

Continuous Bilateral Brachial Plexus Blockade for Acute Pain Control in Patients with Bilateral Upper Extremity Traumatic Injuries: A Review of Five Cases

“…Thus, it is quite evident that bilateral blocks of the brachial plexus may lead to bilateral phrenic nerve blockade and complete paralysis of the diaphragm. However, in sound guidance [23][24][25], which has been shown to significantly reduce the rate of complications of these procedures [4,9]. Overall, hematoma is an extremely rare complication, particularly when ultrasound guidance is utilized [4].…”

“…Additionally, we found one case in the literature of massive hemothorax following a supraclavicular block. This block was performed with the paresthesia technique for needle localization [9]. One notable study which reported complications of supraclavicular blocks, had an 8.8% incidence of hematoma formation [25].…”

“…Other complications that have been described include hemothorax and Horner's syndrome [1,9]. While many of these are self-limiting and clinically insignificant when performed unilaterally, the consequences could be severe if they were to occur bilaterally.…”

Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

“…Although extremely rare, there has been a clinical case report of massive hemothorax following supraclavicular block. 9 In addition to causing respiratory compromise, a large pulmonary effusion can have a significant impact on hemodynamics and cardiac output. For the regional anesthesiologist assessing a hemodynamically unstable patient, evaluation for pleural effusions in addition to potential cardiac compromise is essential.…”