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[Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study].
Braz J Anesthesiol. 2019 Nov - Dec; 69(6):580-586.BJ

Abstract

BACKGROUND AND OBJECTIVES

The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block.

METHODS

Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the "corner pocket". Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥ 25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed.

RESULTS

Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale (NRS) at 24 hours did not differ between groups.

CONCLUSIONS

Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function.

Authors+Show Affiliations

Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Anesthésie Réanimation, Toulouse, França. Electronic address: fabriceferre31@gmail.com.Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Anesthésie Réanimation, Toulouse, França.Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Anesthésie Réanimation, Toulouse, França.Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Anesthésie Réanimation, Toulouse, França.Clinique Médipôle Garonne, Département d'Anesthésie, Toulouse, França.Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Orthopédie Traumatologie, Toulouse, França.Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Orthopédie Traumatologie, Toulouse, França.Université Toulouse 3-Paul Sabatier, Centre Hospitalier Universitaire de Toulouse Purpan, Département d'Anesthésie Réanimation, Toulouse, França.

Pub Type(s)

Journal Article

Language

por

PubMed ID

31796298

Citation

Ferré, Fabrice, et al. "[Hemidiaphragmatic Paralysis After Ultrasound-guided Supraclavicular Block: a Prospective Cohort Study]." Brazilian Journal of Anesthesiology (Elsevier), vol. 69, no. 6, 2019, pp. 580-586.
Ferré F, Mastantuono JM, Martin C, et al. [Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study]. Braz J Anesthesiol. 2019;69(6):580-586.
Ferré, F., Mastantuono, J. M., Martin, C., Ferrier, A., Marty, P., Laumonerie, P., Bonnevialle, N., & Minville, V. (2019). [Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study]. Brazilian Journal of Anesthesiology (Elsevier), 69(6), 580-586. https://doi.org/10.1016/j.bjan.2019.09.002
Ferré F, et al. [Hemidiaphragmatic Paralysis After Ultrasound-guided Supraclavicular Block: a Prospective Cohort Study]. Braz J Anesthesiol. 2019 Nov - Dec;69(6):580-586. PubMed PMID: 31796298.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study]. AU - Ferré,Fabrice, AU - Mastantuono,Jean-Mathieu, AU - Martin,Charlotte, AU - Ferrier,Anne, AU - Marty,Philippe, AU - Laumonerie,Pierre, AU - Bonnevialle,Nicolas, AU - Minville,Vincent, Y1 - 2019/11/30/ PY - 2019/02/22/received PY - 2019/06/11/revised PY - 2019/09/12/accepted PY - 2019/12/5/pubmed PY - 2020/7/25/medline PY - 2019/12/5/entrez KW - Anestesia regional KW - Diaphragmatic paralysis KW - Nervo frênico KW - Paralisia diafragmática KW - Phrenic nerve KW - Regional anesthesia SP - 580 EP - 586 JF - Brazilian journal of anesthesiology (Elsevier) JO - Braz J Anesthesiol VL - 69 IS - 6 N2 - BACKGROUND AND OBJECTIVES: The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block. METHODS: Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the "corner pocket". Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥ 25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed. RESULTS: Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale (NRS) at 24 hours did not differ between groups. CONCLUSIONS: Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function. SN - 0104-0014 UR - https://www.unboundmedicine.com/medline/citation/31796298/[Hemidiaphragmatic_paralysis_after_ultrasound_guided_supraclavicular_block:_a_prospective_cohort_study]_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0034-7094(19)30110-2 DB - PRIME DP - Unbound Medicine ER -