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Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block.
Reg Anesth Pain Med. 2009 Nov-Dec; 34(6):595-9.RA

Abstract

BACKGROUND AND OBJECTIVES

Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis.

METHODS

In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular brachial plexus block without sedation were included. Supraclavicular brachial plexus block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry.

RESULTS

None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume 1, forced vital capacity, peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the ultrasound-guided group (P < 0.05). Two block failures occurred in the nerve stimulation group compared with none in the ultrasound group (P = 0.49). No adverse effects occurred in either group.

CONCLUSIONS

Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis.

Authors+Show Affiliations

Department of Anesthesiology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. s.renes@anes.umcn.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

19916254

Citation

Renes, Steven H., et al. "Hemidiaphragmatic Paresis Can Be Avoided in Ultrasound-guided Supraclavicular Brachial Plexus Block." Regional Anesthesia and Pain Medicine, vol. 34, no. 6, 2009, pp. 595-9.
Renes SH, Spoormans HH, Gielen MJ, et al. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med. 2009;34(6):595-9.
Renes, S. H., Spoormans, H. H., Gielen, M. J., Rettig, H. C., & van Geffen, G. J. (2009). Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Regional Anesthesia and Pain Medicine, 34(6), 595-9.
Renes SH, et al. Hemidiaphragmatic Paresis Can Be Avoided in Ultrasound-guided Supraclavicular Brachial Plexus Block. Reg Anesth Pain Med. 2009 Nov-Dec;34(6):595-9. PubMed PMID: 19916254.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. AU - Renes,Steven H, AU - Spoormans,Hubertus H, AU - Gielen,Mathieu J, AU - Rettig,Harald C, AU - van Geffen,Geert J, PY - 2009/11/18/entrez PY - 2009/11/18/pubmed PY - 2010/2/17/medline SP - 595 EP - 9 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 34 IS - 6 N2 - BACKGROUND AND OBJECTIVES: Supraclavicular brachial plexus block is associated with 50% to 67% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether ultrasound-guided compared with nerve stimulation supraclavicular brachial plexus block using 0.75% ropivacaine results in a lower incidence of hemidiaphragmatic paresis. METHODS: In a prospective randomized observer-blinded controlled trial, 60 patients scheduled for elective elbow, forearm, wrist, or hand surgery under supraclavicular brachial plexus block without sedation were included. Supraclavicular brachial plexus block was performed with 20 mL of 0.75% ropivacaine using either ultrasound or nerve stimulation guidance. Ventilatory function was assessed by ultrasound examination of hemidiaphragmatic movement and spirometry. RESULTS: None of the 30 patients in the ultrasound group showed complete or partial paresis of the hemidiaphragm (95% confidence interval, 0.00-0.14), whereas in the nerve stimulation group, 15 patients showed complete paresis of the hemidiaphragm and 1 patient showed partial paresis of the hemidiaphragm (0% versus 53%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume 1, forced vital capacity, peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the ultrasound-guided group (P < 0.05). Two block failures occurred in the nerve stimulation group compared with none in the ultrasound group (P = 0.49). No adverse effects occurred in either group. CONCLUSIONS: Ultrasound-guided supraclavicular brachial plexus block, using 20 mL of 0.75% ropivacaine with the described technique, is not associated with hemidiaphragmatic paresis. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/19916254/Hemidiaphragmatic_paresis_can_be_avoided_in_ultrasound_guided_supraclavicular_brachial_plexus_block_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=19916254.ui DB - PRIME DP - Unbound Medicine ER -