SEVERE PNEUMOTHORAX AFTER INTERCOSTAL NERVE BLOCKADE - A CASE-REPORT

Background: Intercostal nerve blockade is recognized as an efficient a nd safe regional anesthetic technique. Although an appropriate techniq ue was applied, we report a severe pneumothorax associated with this t ype of regional anesthesia. Methods: A 57-year-old female patient unde rwent block of intercostal nerves 3 to 8 for interstitial radiotherapy of the left breast in the sitting position. Calcified residual foci i n the right upper lobe from a previous primary infection of tuberculos is were diagnosed by preoperative x-ray. After completion of the block s in the midline of the axilla, the patient complained of pain between the scapulas, developed severe dyspnea and panic, and felt as if her Life was in jeopardy. A severe pneumothorax was diagnosed and a chest tube was placed. After the application of the chest tube, the patient recovered quickly. Conclusion: Extra caution should be used in applyin g this procedure to patients with underlying chronic lung disease, esp ecially on the opposite side. Our case demonstrates that in all patien ts undergoing intercostal nerve blockade preference should be given to the approach at the dorsal angulation of the rib in the lateral or pr one position due to its lower risk of pneumothorax.