Tags

Type your tag names separated by a space and hit enter

Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial.
Reg Anesth Pain Med. 2018 Oct; 43(7):720-724.RA

Abstract

BACKGROUND AND OBJECTIVE

Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster.

METHODS

Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB.

RESULTS

The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%-17.1%] vs 24.4% [interquartile range, 10.2%-31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%-11.1%] vs 19.3% [interquartile range, 13.7%-33.2%]; P = 0.001) were also lower in group CP than in group NC.

CONCLUSIONS

The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise.

CLINICAL TRIAL REGISTRATION

This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769.

Authors+Show Affiliations

No affiliation info availableDepartment of Anesthesiology and Pain Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

29746446

Citation

Kang, Ryung A., et al. "Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial." Regional Anesthesia and Pain Medicine, vol. 43, no. 7, 2018, pp. 720-724.
Kang RA, Chung YH, Ko JS, et al. Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial. Reg Anesth Pain Med. 2018;43(7):720-724.
Kang, R. A., Chung, Y. H., Ko, J. S., Yang, M. K., & Choi, D. H. (2018). Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial. Regional Anesthesia and Pain Medicine, 43(7), 720-724. https://doi.org/10.1097/AAP.0000000000000795
Kang RA, et al. Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial. Reg Anesth Pain Med. 2018;43(7):720-724. PubMed PMID: 29746446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced Hemidiaphragmatic Paresis With a "Corner Pocket" Technique for Supraclavicular Brachial Plexus Block: Single-Center, Observer-Blinded, Randomized Controlled Trial. AU - Kang,Ryung A, AU - Chung,Yang Hoon, AU - Ko,Justin Sangwook, AU - Yang,Mi Kyung, AU - Choi,Duck Hwan, PY - 2018/5/11/pubmed PY - 2019/1/10/medline PY - 2018/5/11/entrez SP - 720 EP - 724 JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med VL - 43 IS - 7 N2 - BACKGROUND AND OBJECTIVE: Hemidiaphragmatic paresis is common after supraclavicular brachial plexus block (SCBPB). In this randomized trial, we compared the incidence of hemidiaphragmatic paresis in patients who had local anesthetic injected primarily in the corner pocket (defined as the intersection of the first rib and subclavian artery) during SCBPB with that of patients who underwent injection primarily inside the neural cluster. METHODS: Thirty-six patients scheduled for right elbow, forearm, wrist, or hand surgery under SCBPB (using 12.5 mL of 0.75% ropivacaine and 12.5 mL of 2% lidocaine with 1:200,000 epinephrine) were randomly assigned to 1 of 2 groups. In group CP, local anesthetic was injected primarily in the corner pocket (20 mL) and secondarily inside the neural cluster (5 mL). In group NC, local anesthetic was deposited primarily inside the neural cluster (20 mL) and secondarily in the corner pocket (5 mL). The primary outcome was the incidence of hemidiaphragmatic paresis, as measured by M-mode ultrasonography 30 minutes after SCBPB. RESULTS: The incidence of hemidiaphragmatic paresis was significantly lower in group CP than in group NC (27.8% vs 66.7%, P = 0.019). The median decreases in forced expiratory volume at 1 second (7.5% [interquartile range, 3.3%-17.1%] vs 24.4% [interquartile range, 10.2%-31.2%]; P = 0.010) and forced vital capacity (6.4% [interquartile range, 3.3%-11.1%] vs 19.3% [interquartile range, 13.7%-33.2%]; P = 0.001) were also lower in group CP than in group NC. CONCLUSIONS: The incidence of hemidiaphragmatic paresis was effectively reduced when local anesthetic was injected primarily in the corner pocket during right-sided SCBPB. However, the 28% incidence of hemidiaphragmatic paresis associated with the corner pocket technique may still represent a prohibitive risk for patients with preexisting pulmonary compromise. CLINICAL TRIAL REGISTRATION: This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/29746446/Reduced_Hemidiaphragmatic_Paresis_With_a_"Corner_Pocket"_Technique_for_Supraclavicular_Brachial_Plexus_Block:_Single_Center_Observer_Blinded_Randomized_Controlled_Trial_ L2 - https://rapm.bmj.com/lookup/pmidlookup?view=long&pmid=29746446 DB - PRIME DP - Unbound Medicine ER -