2025 FSA Podium and Poster Abstracts

Introduction: Pneumothorax is a known rare complication of shoulder surgery, brachial plexus regional anesthesia, general endotracheal anesthesia, and can also occur spontaneously. Most regional anesthetics and perioperative nerve block are performed with ultrasound guidance. We present the use of a contrast in a chest plain film to help elucidate further clinical details and management suggestions after a patient experienced a pneumothorax following interscalene perineural catheter placement prior to rotator cuff repair and shoulder arthroscopy.

Case Discussion: Pre-operative plain film of the chest was normal. Smoking and respiratory disease history was negative.  For the interscalene block, ultrasound guidance was used to insert a closed-end catheter and. Post-operatively, after ascertaining the patient developed a tension pneumothorax, a chest tube was placed, the decision was made to inject radio-opaque contrast via the interscalene catheter and repeat the chest plain film to ascertain if the catheter tip remained in the neck or was inadvertently mispositioned. Once the catheter was determined to be appropriately positioned, it was maintained and reconnected to a portable, rate controlled local anesthetic dispenser. The patient was observed and later discharged home on post-operative day 2 without further complication.

Conclusion: While many elements of the imaging process must be considered to minimize patient risk, this study finds the use of contrast to further guide evaluation and management of a postoperative complication. In this situation, it didn't elucidate whether the pneumothorax resulted from general endotracheal anesthesia, the interscalene block, or surgical procedure, but it helped determine that it was safe and reasonable to continue use of the perineural catheter.