Surgical Treatment of Permanent Diaphragm Paralysis after Interscalene Nerve Block for Shoulder Surgery

Kaufman, Matthew R.; Elkwood, Andrew I.; Rose, Michael I.; Patel, Tushar R.; Ashinoff, Russell L.; Fields, Ryan G.; Brown, David P.

doi:10.1097/aln.0b013e31829c2f22

Cited by 51 publications

(36 citation statements)

References 14 publications

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“…Inflammatory mechanisms have recently been proposed as the cause for persistent phrenic nerve injury following interscalene block for shoulder surgery. Kaufman and colleagues 46 reported a series of 14 patients with chronic diaphragmatic paralysis following interscalene block. During surgical exploration, adhesions, fascial thickening, vascular changes, and scar tissue (present in 10 of 14 patients) involving the phrenic nerve suggested chronic inflammation and were consistent with a compression neuropathy.…”

Section: Inflammatory Injurymentioning

confidence: 99%

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Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

184

106

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Section: Inflammatory Injurymentioning

confidence: 99%

“…52 However, surgical literature warns that the risk of block-related PNI may be higher than that reported in anesthesia literature. 46,[53][54][55] In the following section, we discuss several technical, equipment, and anatomical factors that may influence the risk of nerve injury.…”

Section: Anesthetic Factorsmentioning

confidence: 99%

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Brull

Hadžić

Reina

et al. 2015

Regional Anesthesia and Pain Medicine

184

106

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“…[5] Although HDP is usually transient, rare cases of prolonged or persistent HDP after single-injection or continuous ISB have been reported. [6–8] The incidence of persistent HDP following ISB for shoulder surgery is of 1 per 2069 (0.048%). [9] …”

Section: Discussionmentioning

confidence: 99%

“…[11] A recent study suggested that inflammation played a significant role in the mechanism of persistent HDP. [8] The study reported intraoperative findings of adhesions, fascial thickening, and vascular changes secondary to inflammation during phrenic nerve surgery. However, although inflammation might play a crucial role in the mechanism of nerve injuries, it is unclear whether this results from the catheter or from other factors.…”

Section: Discussionmentioning

confidence: 99%

Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block

et al. 2016

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Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. However, it is generally transient and is resolved over the duration of the local anesthetic's action.We present a case of a patient who experienced prolonged hemidiaphragmatic paresis following a continuous interscalene brachial plexus block for the postoperative pain management of shoulder surgery, and suggest a mechanism that may have led to this adverse effect.Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries.

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“…This is associated with significant side effects including phrenic nerve paralysis approaching 100 %, especially with traditional, high volume blocks [47]. Permanent phrenic nerve dysfunction is rare but can be a devastating injury impeding respiratory function [48]. Supraclavicular brachial plexus blocks are a reasonable analgesic alternative and carry slightly less risk of diaphragm paraesis.…”

Section: Upper Limb Surgerymentioning

confidence: 99%

Pain Management for Ambulatory Surgery: What Is New?

Hagen

Iohom

2014

Curr Anesthesiol Rep

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Safe ambulatory surgery mandates the provision of an anesthetic 'package', or care bundle commensurate with surgery, which enables the patient (or their guardian) to manage their pain at home. Anesthesia providers must therefore plan and implement analgesic regimens that commence in the preoperative phase, continue through the intraoperative and recovery periods and into the outpatient setting. Multimodal analgesia is the mainstay of successful ambulatory surgery analgesia. A combination of opioid and nonopioid analgesics, as well as local or regional techniques is likely to ensure the best patient outcome. There is a clear trend toward more peripheral selective nerve blocks and wound infiltration.

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Surgical Treatment of Permanent Diaphragm Paralysis after Interscalene Nerve Block for Shoulder Surgery

Cited by 51 publications

References 14 publications

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block

Pain Management for Ambulatory Surgery: What Is New?

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