Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function

Mak, Peter; Irwin, Michael G.; Ooi, Clara; Chow, B. F. M.

doi:10.1046/j.1365-2044.2001.01708-2.x

Cited by 106 publications

(64 citation statements)

References 17 publications

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“…This resulted in sudden onset of inspiratory stridor and severe respiratory distress. The concomitant phrenic nerve block, which can be anesthetized (36-67%) when a supraclavicular block is performed, might have further aggravated the patient's symptoms [2,3]. The onset time of inspiratory stridor in our patient coincided with the development of sensory loss and muscle weakness in the ipsilateral limb.…”

Section: Discussionmentioning

confidence: 79%

“…Acute respiratory complications in the form of phrenic and recurrent laryngeal nerve (RLN) palsies have been reported but are usually of no or minimal clinical significance [2][3][4]. We encountered a case of severe respiratory distress after right-sided supraclavicular block in a patient with unrecognized pre-existing leftsided vocal cord palsy.…”

Section: Introductionmentioning

confidence: 98%

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Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

et al. 2011

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Brachial plexus block is commonly used for upper limb surgery. Although the procedure is safe, it may be associated with some life-threatening complications. We performed right-sided supraclavicular brachial plexus block for below-elbow amputation in a 45-year-old female. At completion of the block the patient developed marked respiratory difficulty with audible inspiratory stridor. Although SpO(2) decreased to 82% initially, it was increased to 100% by continuous positive airway pressure with a face mask. On conventional direct laryngoscopy, the left vocal cord was found to be in the midline position and the right vocal cord was in the paramedian position. The trachea was intubated and surgery proceeded without any other complication. Postoperative indirect laryngoscopy revealed that the left vocal cord was fixed, whereas the right vocal cord was mobile, and diagnosis of pre-existing incomplete left vocal cord paralysis was made. This clinical report is to emphasize the importance of thorough pre-operative evaluation of the vocal cord in patients who have undergone any surgical procedure or radiation treatment of the neck before planning for brachial plexus block. If such an evaluation cannot be obtained, an alternative technique, for example axillary approach, should be preferred.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 98%

Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

et al. 2011

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“…Their study showed the most common pattern of the phrenic nerve consists of phrenic nerve with single C3 and C4 rootles with an immeasurable C5 which was present in 26% of the necks. and post operative complications (MAK, 2001). Another set of our findings revealed some variations of the pericardium.…”

Section: Discussionmentioning

confidence: 90%

Bilateral variations in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver

Ahmadpour

Foghi

2016

J Morphol Sci

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Phrenic nerve provides the major motor supply to diaphragm. Various anatomical variations in the course and distribution of the phrenic nerve have reported before. Here we report a rare bilateral asymmetric variation in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver. Specifically, the right phrenic nerve was arising from the upper trunk of the brachial plexus (C5) and the left side nerve originated from the supraclavicular nerve and a tiny branch from C5. In the same cadaver both sides phrenic nerve were buried in the mediastinal pleura. Another interesting finding was absence of the fibrous pericardium. To the best of our knowledge the presented case showed a very rare variation in the roots of origin of the phrenic nerve accompanied with pericardial anomaly which has been less reported. We think such case is of practical importance during supraclavicular block during anesthesia

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“…Interscalene block is commonly associated with decreased diaphragmatic motion and pulmonary function when tested by ultrasonography and spirometry, repectively. [9][10][11] The duration of diaphragmatic paralysis is variable, lasting from 75 min to four hours depending on the type of cervical block and whether epinephrine is used in combination with the local anesthetic. 8,12 Superficial cervical block, unlike the deep block, carries a low risk of complications related to nerve paralysis.…”

Section: Discussionmentioning

confidence: 99%

Unexplained fever after bilateral superficial cervical block in children undergoing cochlear implantation: an observational study

Merdad

Crawford

Gordon

et al. 2011

Can J Anesth/J Can Anesth

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Purpose In an effort to decrease postoperative opioid requirements, intraoperative bilateral superficial cervical plexus block (BSCPB) was recently adopted for all our children undergoing general anesthesia for bilateral simultaneous cochlear implantation (BSiCI). Several cases of early postoperative fever were noted after the adoption of BSCPB. Our aim was to determine if an association exists between BSCPB and early postoperative fever in children undergoing BSiCI. As a secondary outcome, we studied the efficacy of BSCPB in altering postoperative analgesic requirements. Methods We conducted a retrospective cohort study of 91 consecutive children who underwent BSiCI. The series included 34 patients who received BSCPB (Block Group) and 57 patients who did not receive BSCPB (No-block Group). Results The median age (range) was 15.4 months (eight months -15 yr). A significant association was found between BSCPB and postoperative fever (P = 0.006). Eighteen (19.7%) children developed fever in the first 24 hr after surgery (Block Group: 12/34 [35%]; No-block Group: 6/57 [11%]; P = 0.006). The Block Group was 4.8 times more likely to develop early postoperative fever after adjusting for other variables (P = 0.004). The Block Group spent more days in hospital after surgery compared with the No-block Group (P = 0.043). Other vital signs showed no major deviation from the normal ranges, and daily physical examinations revealed no obvious source of infection in children who developed postoperative fever. Conclusion Bilateral superficial cervical plexus block may increase the risk of postoperative fever in children undergoing BSiCI. In this series, BSCPB was associated with a longer hospital admission. The etiology of the fever is undetermined, although it can be hypothesized that BSCPB resulted in unintended block of the phrenic nerves leading to diaphragmatic paralysis, atelectasis, and early postoperative fever in young children. RésuméObjectif Dans un effort visant a`diminuer les besoins postope´ratoires en morphiniques, le bloc bilate´ral perope´ratoire du plexus cervical superficiel (BSCPB) a e´teŕ e´cemment adopte´pour tous les enfants ayant une anesthe´sie ge´ne´rale pour implantation cochle´aire bilate´rale simultane´e (BSiCI). Plusieurs cas de fie`vre postope´ratoire pre´coce ont e´teć onstate´s apre`s l'adoption du BSCPB. Notre but e´tait de de´terminer s'il existe une association entre le BSCPB et la fie`vre postope´ratoire pre´coce chez des enfants subissant une BSiCI. Nous avons e´galement e´tudie´comme crite`re d'e´valuation secondaire l'efficacite´du BSCPB a`modifier les besoins en analge´siques postope´ratoires. Méthodes Nous avons mene´une e´tude de cohorte re´trospective sur 91 enfants conse´cutifs subissant une BSiCI. La se´rie a inclus 34 patients qui avaient eu un

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Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function

Cited by 106 publications

References 17 publications

Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

Severe stridor and marked respiratory difficulty after right-sided supraclavicular brachial plexus block

Bilateral variations in the roots of origin of the phrenic nerve and absence of fibrous pericardium in an old male cadaver

Unexplained fever after bilateral superficial cervical block in children undergoing cochlear implantation: an observational study

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