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.
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