hemothorax with paravertebral block

Started by ZZDOC, March 29, 2006, 03:34:53 AM

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A paitent for bilateral breast augmemtation was administered a bilateral throasic paravertebral block T-2 to T-6.  A 25g 1.5" needle was used. the vertebral levels were identified and marked and a point 2.5 cm lateraly was marked.  The needle was inserted and the lateral veterbral process was identified.  The needle was walked off the lateral process and inserted 1cm further.  There was negative aspirate for blood, csf and air at each level.  4cc of 0.5% ropivacaine with epinephrine 1:100,000, was injected at each level bilateral. VS were stableduring and after the block.  A general anesthesia was then preformed.  The pt 's surgery was 2 hours long.  The patient awoke at the end of the procedure and was extubated with spontaneous respirations.  The patient was pain free and discharged home after an hour in the recovery room.  4 days later the pt presented to the ER with coughing and shortness of breath.  An H&H revealed severe anemia.  CXR showed a hemothorax unilateraly.  A chest tube was inserted and 1.5 liters of old but not clotted blood was evacuated.  The patient spent the night in ICU for observation. the chest tube was removed the following day aftoer 12 hours of no further drainage.  My question is what is the incidence of this complication and could it have been discovered sooner.  The patient was not on any anticoagulants.  Does anyone know of any liturature that address this complication.  The patient was healthy 30yr old, 5'0" 89lbs.