Case Study of Phrenic Nerve Paralysis: “I Can't Breathe!”

Doyle, Michael P.; McCarty, James P.; Lazzara, A.

doi:10.1016/j.jemermed.2020.03.023

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Another complication is diaphragmatic elevation caused by hemi-diaphragmatic paralysis. While the incidence of hemi-diaphragmatic paralysis varies from 1 to 85%,[ 21 , 22 ] diaphragmatic elevation developed in only one (0.58%) patient in our series due to hemi-diaphragmatic paralysis. This difference can be attributed to the fact that cases that do not cause any clinical symptoms or have significant elevation on X-ray could not be detected in our study.…”

Section: Discussionmentioning

confidence: 67%

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

et al. 2023

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Objectives This study aims to evaluate the severity of postoperative pain and the time to the onset of pain after arthroscopic surgical treatment of rotator cuff tear or instability under interscalene block. Patients and methods Between October 2015 and June 2016, a total of 172 patients (82 males, 90 females; mean age: 47.9±16.9 years; range, 15 to 83 years) who underwent shoulder arthroscopy under interscalene block by a single surgeon were retrospectively analyzed. The relationship between the postoperative 24-h Visual Analog Scale (VAS), the time to the onset of pain with the type of surgical procedure (rotator cuff repair, n=101 or instability surgery, n=71), and the duration of surgery (<30 min n=92; ≥30 min n=80) was examined. Results No significant relationship was found between the type of surgical procedure, VAS scores, and the onset of pain after the block (p=0.577 and p=0.780, respectively). No significant relationship was found between the operation duration, and VAS, and the onset of pain after the block (p=0.570 and p=0.408, respectively). The mean duration until the start of postoperative pain was 734±313 (range, 60 to 1,440) min. There was no statistically significant difference in the need for rescue analgesics at the postoperative 24 th h and the duration of surgery between the two groups (p=0.393 and p=0.675, respectively). Conclusion Our study results show no significant difference in the time for the onset of postoperative pain and the VAS scores according to the characteristics of the surgical procedure, operation duration, or age and sex of the patient. Shoulder arthroscopy performed by experienced surgeons under interscalene block eliminates the need for analgesics within the first 12 h postoperatively.

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Section: Discussionmentioning

confidence: 67%

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

et al. 2023

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“…Although precautions with the ISB procedure are typically reserved for those with chronic lung disease, case reports of clinically evident phrenic nerve paralysis have occurred after ISB in otherwise healthy patients [27][28][29]. Unique to these cases is difficult anatomy requiring multiple injections [23] or the use of very large volumes of LA [28,29].…”

Section: Discussionmentioning

confidence: 99%

A Case of Hospitalization After Pre-operative Interscalene Nerve Block in an Ambulatory Surgery Center

Desai,

Willson,

Chitty

et al. 2024

Cureus

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Interscalene nerve block (ISB) is an effective and low-risk local anesthetic (LA) procedure that is commonly employed for shoulder surgery. While phrenic nerve involvement occurs to some degree in every ISB procedure, the incidence of hypoxemia and other clinical signs of diaphragmatic disruption is much lower. This is a case of a 36-year-old female with no underlying respiratory disease who developed hypoxemia requiring a night of observation following an ISB for a rotator cuff repair procedure in an ambulatory surgical center. Her hypoxemia was easily treated with supplemental oxygen and she made a full recovery by the next day. The use of ultrasound guidance, reduced LA volume, less potent medication, sterile fluid for optimal visualization, and extrafascial administration should be considered for all patients receiving an ISB to prevent respiratory complications.

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“…We found four case reports describing the identification of hemidiaphragmatic dysfunction with DUS. The underlying causes were phrenic nerve paralysis, dermatomyositis exacerbation, brachial plexus damage and amyotrophic lateral sclerosis, but diaphragm dysfunction assessment was the main finding that led to the correct diagnosis [63,[77][78][79].…”

Section: Diaphragm Ultra-sound (Dus)mentioning

confidence: 99%

The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment

Sartini,

Ferrari,

Cutuli

et al. 2024

JCM

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Acute respiratory failure (ARF) is a challenging condition that clinicians, especially in emergency settings, have to face frequently. Especially in emergency settings, many underlying diseases can lead to ARF and life-threatening conditions have to be promptly assessed and correctly treated to avoid unfavorable outcomes. In recent years, point-of-care ultrasound (POCUS) gained growing consideration due to its bedside utilization, reliability and reproducibility even in emergency settings especially in unstable patients. Research on POCUS application to assess ARF has been largely reported mainly with observational studies showing heterogeneous results from many different applications. This narrative review describes the wide potentiality of POCUS to face airways and breathing life-threatening conditions such as upper airway management, pulmonary and pleural pathologies and diaphragm impairment. We conducted extensive research of the literature to report from major studies to case reports deemed useful in practical clinical utilization of POCUS in ARF. Due to the huge amount of the literature found, we focused on airways and breathing assessment trying to systematize the evidence according to clinical care of ARF in emergency settings. Further studies, possibly trials, should determine how POCUS is crucial in clinical practice in terms of standard of care improvements, patient safety and cost-benefit analysis.

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Case Study of Phrenic Nerve Paralysis: “I Can't Breathe!”

Cited by 5 publications

References 15 publications

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

Interscalene block applied by an experienced anesthesiologist has a good anesthetic effect, a long duration of action, and less postoperative pain after arthroscopic shoulder procedures independent of surgery type and operation duration

A Case of Hospitalization After Pre-operative Interscalene Nerve Block in an Ambulatory Surgery Center

The Role of Pocus in Acute Respiratory Failure: A Narrative Review on Airway and Breathing Assessment

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