A 64-yr-old woman underwent an arthroscopic rotator cuff repair under general anesthesia plus brachial plexus block. On emergence, she complained of right-sided chest pain and dyspnea, with mild hypoxemia requiring supplemental oxygen. Chest x-ray film (fig.) ruled out pneumothorax and confirmed the presence of extensive air and fluid in the soft tissues of the right shoulder, chest, and lower neck. The image showed no hemidiaphragmatic elevation, pulmonary edema, pleural effusion, or atelectasis. A thoracic erector spinae block was performed, which relieved the patient’s chest pain and dyspnea.

The differential diagnosis of dyspnea after arthroscopic shoulder surgery and interscalene brachial plexus block includes hemidiaphragmatic paresis and pneumothorax, and other etiologies associated with general anesthesia if they apply. Fluid extravasation into the shoulder and chest is common and can cause chest pain and tightness with subjective respiratory distress. Actual...

You do not currently have access to this content.