Permanent hemidiaphragmatic paresis after interscalene brachial plexus block: a case report

Cugnin, Nina; Gaillard, Benjamin Le; Neto, Edmundo Pereira de Souza

doi:10.1016/j.bjane.2021.02.009

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…The activity of the accessory respiratory muscles may overcome the diaphragmatic paresis and paralysis 22,23 . This is in line with the results of this study that revealed that the postoperative pulmonary function tests were comparable between the three used volumes of local anesthetics 24 . This study is limited by being a single-center study with low sample size.…”

Section: Discussionsupporting

confidence: 92%

Respiratory effects and analgesic efficacy of different local anesthetic volumes in ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy: Prospective randomized study

Ahmed,

Lotfy,

Abduallah

et al. 2024

Acta Anaest Belg

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Background: The exact volume of local anesthetics that can be used in interscalene brachial plexus (ISBP) that produce adequate analgesia with minimal effect on phrenic nerve is a matter of debate. Objectives: This study aimed to compare the effect of three different volumes of local anesthetics in (ISBP) on the incidence of diaphragmatic hemiparesis and the postoperative analgesia in patients scheduled for shoulder arthroscopy. Design: Prospective Randomized Double-blind study. Setting: Single-center study. Methods: Seventy-five patients scheduled for shoulder arthroscopy were randomly distributed into three groups according to the volume of levobupivacaine 0.25% used in ISBP block; - (group I: 5 ml), (group II: 10 ml), and (group III: 15 ml). Main outcome measures: The incidence of diaphragmatic hemiparesis (primary outcome) was assessed by ultrasound assessment of diaphragmatic excursion. Moreover, the postoperative pain score and the rescue analgesic consumption were measured (secondary outcomes). Results: The incidence of diaphragmatic hemiparesis or paralysis was higher in group III in comparison to groups I and II (P = 0.019 and 0.037) with no statistically significant difference between groups I and II (P = 0.576). The postoperative pain score was significantly lowered in groups II and III as compared to group I (P < 0.05). The postoperative tramadol consumption was higher in group I in comparison to groups II and III (P = 0.0011 and 0.009) with a non-statistically significant difference between groups II and III (P = 0.577). Conclusion: The use of 10 ml volume of levobupivacaine 0.25% in ISBP block had a lesser incidence of diaphragmatic hemiparesis or paralysis in comparison to the use of 15 ml volume and had a better postoperative analgesic profile in comparison to the use of 5 ml volume. Trial registration: The study was registered at clinicaltrial.gov (I.D: NCT04549779)

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Section: Discussionsupporting

confidence: 92%

Respiratory effects and analgesic efficacy of different local anesthetic volumes in ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy: Prospective randomized study

Ahmed,

Lotfy,

Abduallah

et al. 2024

Acta Anaest Belg

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Effect of Ropivacaine in Combined Costoclavicular Brachial Plexus - Cervical Plexus Blocks on Hemidiaphragmatic Paralysis for Humeral Fracture Surgery: A Prospective Single - Centre Cohort Study

Zhu,

Yuan,

Mei

et al. 2024

DDDT

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Background The brachial plexus block is conducive to providing postoperative analgesia for patients with humeral fractures. The commonly used brachial plexus block techniques have a high incidence rate of hemidiaphragmatic paralysis (HDP), which may lead to respiratory problems. The combined costoclavicular brachial plexus - cervical plexus blocks (CCB-CPBs) had demonstrated favorable analgesic effects and had reduced the incidence of HDP in shoulder surgeries. However, the clinical experience regarding CCB-CPBs is rather limited. Consequently, our study aims to evaluate its various effects, such as the diaphragmatic and pulmonary functions, as well as the analgesia for humeral fracture surgeries. Patients and Methods We enrolled 30 patients who were slated to undergo surgery for humeral fractures under the combined use of nerve block and general anesthesia. All the patients underwent CCB-CPBs under the guidance of an ultrasound and a nerve simulator. The anesthetic dosage consisted of 20 ml and 10 ml of 0.5% ropivacaine respectively. Following the operation, all the patients were transferred to the Post-Anesthesia Care Unit (PACU). The diaphragmatic excursion, spirometry outcomes, pain score, along with the sensory and motor block, were evaluated. Results The diaphragmatic excursion was significantly reduced during the post-block period in contrast to the pre-block period. The mean change in diaphragmatic excursion (with the mean value [SD]) was −25.3 [48.6] %, accompanied by a P -value of 0.001. The forced vital capacity (FVC) during the post-block period was approximately 7% lower compared to that during the pre-block period, with a P -value of 0.032. The numerical rating scale (NRS) scores of the patients in the PACU were 0 (0–0). Conclusion CCB-CPBs can result in a reduction in hemidiaphragm excursion and may slightly affect lung function to some extent. Nevertheless, they can provide a favorable analgesic effect for humeral fracture surgery. Therefore, patients with poor respiratory reserve should exercise caution when using it.

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Permanent hemidiaphragmatic paresis after interscalene brachial plexus block: a case report

Cited by 2 publications

References 11 publications

Respiratory effects and analgesic efficacy of different local anesthetic volumes in ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy: Prospective randomized study

Respiratory effects and analgesic efficacy of different local anesthetic volumes in ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy: Prospective randomized study

Effect of Ropivacaine in Combined Costoclavicular Brachial Plexus - Cervical Plexus Blocks on Hemidiaphragmatic Paralysis for Humeral Fracture Surgery: A Prospective Single - Centre Cohort Study

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