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Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study.
Korean J Pain. 2020 Apr 01; 33(2):144-152.KJ

Abstract

BACKGROUND

Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach.

METHODS

This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated.

RESULTS

Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis.

CONCLUSIONS

The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

Authors+Show Affiliations

Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.College of Nursing, Chungnam National University, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University, Daejeon, Korea. Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32235015

Citation

Oh, Chahyun, et al. "Costoclavicular Brachial Plexus Block Reduces Hemidiaphragmatic Paralysis More Than Supraclavicular Brachial Plexus Block: Retrospective, Propensity Score Matched Cohort Study." The Korean Journal of Pain, vol. 33, no. 2, 2020, pp. 144-152.
Oh C, Noh C, Eom H, et al. Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study. Korean J Pain. 2020;33(2):144-152.
Oh, C., Noh, C., Eom, H., Lee, S., Park, S., Lee, S., Shin, Y. S., Ko, Y., Chung, W., & Hong, B. (2020). Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study. The Korean Journal of Pain, 33(2), 144-152. https://doi.org/10.3344/kjp.2020.33.2.144
Oh C, et al. Costoclavicular Brachial Plexus Block Reduces Hemidiaphragmatic Paralysis More Than Supraclavicular Brachial Plexus Block: Retrospective, Propensity Score Matched Cohort Study. Korean J Pain. 2020 Apr 1;33(2):144-152. PubMed PMID: 32235015.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study. AU - Oh,Chahyun, AU - Noh,Chan, AU - Eom,Hongsik, AU - Lee,Sangmin, AU - Park,Seyeon, AU - Lee,Sunyeul, AU - Shin,Yong Sup, AU - Ko,Youngkwon, AU - Chung,Woosuk, AU - Hong,Boohwi, PY - 2019/08/23/received PY - 2019/12/06/revised PY - 2020/01/20/accepted PY - 2020/4/3/entrez PY - 2020/4/3/pubmed PY - 2020/4/3/medline KW - Anesthesia KW - Brachial Plexus Block KW - Diaphragm KW - Incidence KW - Nerve Block KW - Paralysis KW - Phrenic Nerve KW - Propensity Score KW - Retrospective Studies KW - Ultrasonography SP - 144 EP - 152 JF - The Korean journal of pain JO - Korean J Pain VL - 33 IS - 2 N2 - BACKGROUND: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. METHODS: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. RESULTS: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. CONCLUSIONS: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block. SN - 2005-9159 UR - https://www.unboundmedicine.com/medline/citation/32235015/Costoclavicular_brachial_plexus_block_reduces_hemidiaphragmatic_paralysis_more_than_supraclavicular_brachial_plexus_block:_retrospective_propensity_score_matched_cohort_study_ L2 - http://www.epain.org/journal/view.html?volume=33&amp;number=2&amp;spage=144 DB - PRIME DP - Unbound Medicine ER -
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