Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000500014
Brazilian Journal of Anesthesiology
Clinical Information

Pneumotórax pós-bloqueio de plexo braquial guiado por ultrassonografia: relato de caso

Pneumothorax post brachial plexus block guided by ultrasound: a case report

Beatriz L. S. Mandim; Rodrigo R Alves; Rodrigo Almeida; João Paulo J. Pontes; Lorena J. Arantes; Fabíola P. Morais

http://dx.doi.org/10.1590/S0034-70942012000500014 Braz J Anesthesiol, vol.62, n5, p.744-747, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: O bloqueio do plexo braquial é usado para anestesia nos membros superiores. O uso da ultrassonografia (USG) como técnica de bloqueio vem se popularizando nos últimos anos, facilitando a realização do bloqueio por fornecer imagens em tempo real do plexo e das estruturas circunjacentes, além de minimizar as complicações. O objetivo deste relato foi descrever um caso de pneumotórax após bloqueio interescalênico guiado por ultrassonografia. RELATO DE CASO: Paciente masculino, 49 anos, 62 kg e 1,72 m, longilíneo, tabagista, assintomático, ASA II E. Submetido a tratamento cirúrgico de fratura exposta de ulna direita com bloqueio de plexo braquial via interescalênica guiada por USG com complementação por via axilar. Após sedação e antissepsia, foi colocado o probe linear do aparelho de USG perpendicular à fenda interescalênica (12 Hz) e introduzido stimucath A50, in plane. Após visualização dos troncos nervosos, foi feita injeção de 20 mL de Ropivacaína 0,5% com complementação do bloqueio via axilar (mesmo volume e concentração de anestésico). Ao término da cirurgia, o paciente queixou-se de dor torácica ventilatório-dependente associada à dispneia e queda da oximetria de pulso (91% em ar ambiente), mantendo-se, entretanto, estável hemodinamicamente (PA = 130/70 e FC = 84 bpm). Apesar de ausculta pulmonar normal, o RX de tórax solicitado evidenciou presença de pneumotórax à direita. Feita drenagem torácica fechada em selo d'água, após a qual o paciente referiu melhoria dos sintomas. Alta em bom estado geral após oito dias. CONCLUSÃO: Apesar da visualização dinâmica das estruturas cervicais com o aparelho de USG, o bloqueio interescalênico pode resultar em pneumotórax. A cúpula pleural mais elevada do que o habitual, devido a um pulmão hiperinsuflado (tabagismo), provavelmente facilitou a punção pleural inadvertida.

Palavras-chave

COMPLICAÇÕES, Pneumotórax, EQUIPAMENTOS, Ultrassom, TÉCNICAS ANESTÉSICAS, Regional, plexo braquial

Abstract

BACKGROUND AND OBJECTIVES: Brachial plexus block is used for upper limbs anesthesia. The use of ultrasound-guided (USG) technique for blockade has become popular in recent years, facilitating its execution by providing real-time images of the plexus and surrounding structures while minimizing complications. The purpose of this report is to describe a case of pneumothorax following ultrasound-guided interscalene block. < CASE REPORT: Male patient, 49 years old, weight 62 kg and height 1.72 m, slender, smoker, asymptomatic, ASA II E. The patient underwent surgical repair of right ulna open fracture through USG-guided interscalene brachial plexus block with axillary supplementation. After sedation and antisepsis, the linear probe of the USG apparatus was placed perpendicular to the interscalene groove (12 Hz), and stimucath A50 introduced in plane. After visualization of nerve trunks, 20 mL of ropivacaine 0.5% was administered with axillary block suplementation (same volume and concentration of anesthetic). At the end of surgery, the patient complained of respiratory-dependent chest pain associated with dyspnea and decreased pulse oximetry (91% in room air), but hemodynamic stable (BP = 130/70 and HR = 84 bpm). Although pulmonary auscultation was normal, chest X-ray showed the presence of right pneumothorax. Water seal chest drainage was performed, after which the patient reported improvement of symptoms and was discharged from hospital in good general condition after 8 days. CONCLUSION: Despite the dynamic visualization of cervical structures with USG, interscalene block may result in pneumothorax. An unusual higher pleural dome due to the hyperinflated lung (smoking) probably facilitated the accidental pleural puncture.

Keywords

Anesthesia, Conduction, Brachial Plexus, Ultrasonography, Pneumothorax

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