Postoperative Respiratory Distress Complicating Attempted Paravertebral Blockade: A Case Report and Review of the Literature

Paravertebral blockade is a useful adjunct for pain relief following thoracotomy. We describe a patient where a presumed paravertebal catheter was the cause of acute respiratory distress on postoperative day number two in a patient who underwent a thoracotomy. The catheter was placed using a well-described loss of resistance technique which, by itself, may increase the risk of complications associated with this block in patients who have had a prior thoracotomy. Computed tomographic images revealed an intrapleural catheter which was discontinued leading to a resolution of the patient's symptoms. This case underscores the importance of using additional confirmatory modalities beyond the loss of resistance technique when placing a paravertebral catheter in patients who have had a prior thoracotomy. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.