What complications of nerve block anesthesia are of special concern to the ambulatory patient?
The potential for pneumothorax must be considered when performing approaches to the brachial plexus other than the more commonly practiced and inherently safer axillary approach (supraclavicular, infraclavicular, and interscalene). This complication may necessitate placement of a chest tube or prolonged observation. The occurrence of central nervous system toxicity ranging from tinnitus to frank seizures secondary to an intravascular injection during an attempted block may delay the onset of surgery but should not prevent eventual discharge from the PACU on the day of surgery. General anesthesia, rather than a repeat block, should be induced after it has been determined that the patient has fully recovered neurologically and after this has been documented on the anesthesia record.