Vanish the fear or strike it - Inadvertent plural puncture during regional anesthesia !

[DrAmir0078]

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Hi SDN Anesthesiologists,
I was discussing with my colleague PGY3 about inadvertent plural puncture during regional anesthesia of any technique.
So my concern is about that fear, am I or are we exaggerating it?
Let us say, I punctured the plura with this 21G needle, what shall I do?
- withdraw the needle a bit and continue the block? + Observe!
- Abolish the technique and request thoracic consult?

Is their any helpful data about the prevalence of plural puncture and complications after regional anesthesia and how to deal with it?

Is it a stigma?

So, I hope I can find the answer which is either will vanish the fear or strike it more or make me much aware with your knowledge and experience.

Sincerely,
Amir

 

[drmwvr]

Never seen that with a regional block, but I've seen plenty with sc venous access and even thyroid needle biopsy.

The puncture from the thyroid bx only declared itself after the patient came for unrelated surgery a couple of days later during positive pressure ventilation. Probably would never have been picked up otherwise.

I suspect you'd treat your scenario the same as if you thought you got into the lung with a central line attempt, and follow accordingly.

 

[chessknt]

If you hit the pleura just use your ultrasound and check for lung sliding. Might need to do it again if patient is being put on positive pressure ventilation.

 

[NoodleIncident]

Happened to a partner of mine doing an infraclavicular with a continuous block needle. I don’t recall if they used ultrasound. Wound up doing the case and placing a pigtail chest drain and stayed the night.