Tags

Type your tag names separated by a space and hit enter

Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique.
Pain Physician. 2021 12; 24(8):507-515.PP

Abstract

BACKGROUND

An interscalene brachial plexus block is a commonly conducted nerve block for anesthesia and analgesia in shoulder surgery. Due to its proximity to the targeted nerve, the phrenic nerve, which innervates the diaphragm, is typically inadvertently blocked by ventral spread of the local anesthetic. Although hemidiaphragmatic paresis is tolerable in healthy patients, it would be an irreversible risk to patients with compromised lung reserve.

OBJECTIVES

To investigate the effect of interscalene brachial plexus block on hemidiaphragmatic paresis by comparing the conventional local anesthetic volume with a reduced experimental volume at a more specific position using an ultrasound-guided 2-point injection technique.

STUDY DESIGN

Prospective, randomized controlled study registered with the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp. KCT0005575. 04/11/2020).

SETTING

This study was conducted at a single hospital affiliated with an academic institution between April and December 2020.

METHODS

Patients undergoing brisement manipulation and arthroscopic shoulder surgery were randomized to the experimental (10 mL of ropivacaine 0.5%) and control groups (15 mL of ropivacaine 0.5%). Fifty-two patients who received an interscalene brachial plexus block for anesthesia and analgesia in the shoulder region. The interscalene block was performed using a 2-point injection and observing the spread pattern of the local anesthetic. The primary outcome was the incidence of hemidiaphragmatic paresis, estimated by the thickening fraction of the diaphragm. The secondary outcomes included oxygen saturation, presence of dyspnea, resting pain score, and handgrip strength score.

RESULTS

Thickening fraction was significantly decreased in the control group compared with the experimental group (median [interquartile range], 13.9 [10.0-18.5] versus 28.5 [14.5-38.8], P < 0.001). The incidence of hemidiaphragmatic paresis was significantly higher in the control group than in the experimental group (92.3% versus 53.8%, P = 0.004). Handgrip strength was significantly reduced in the control group compared with the experimental group (P = 0.029).

LIMITATIONS

We did not perform a phrenic nerve conduction study, as it is rarely performed in routine clinical operations. We did not formally assess the distance and spatial relationship of the phrenic nerve to the targeted nerve. Outcome variables including pain assessment were limited to the immediate postoperative period.

CONCLUSIONS

Reducing the local anesthetic volume by selective injection and observing the spread pattern resulted in a decreased incidence of hemidiaphragmatic paresis and preserved handgrip strength after interscalene block.

Authors+Show Affiliations

Department of Medical Sciences, Hallym University Graduate School, Chuncheon, Republic of Korea.Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

34793637

Citation

Kim, Ki Seok, et al. "Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique." Pain Physician, vol. 24, no. 8, 2021, pp. 507-515.
Kim KS, Ahn JH, Yoon JH, et al. Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique. Pain Physician. 2021;24(8):507-515.
Kim, K. S., Ahn, J. H., Yoon, J. H., Ji, H. T., & Kim, I. S. (2021). Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique. Pain Physician, 24(8), 507-515.
Kim KS, et al. Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique. Pain Physician. 2021;24(8):507-515. PubMed PMID: 34793637.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemidiaphragmatic Paresis Following Interscalene Brachial Plexus Block With 2-Point Injection Technique. AU - Kim,Ki Seok, AU - Ahn,Jnug Hwan, AU - Yoon,Ju Hyun, AU - Ji,Ho Tae, AU - Kim,Il Seok, PY - 2021/11/18/entrez PY - 2021/11/19/pubmed PY - 2021/12/17/medline KW - brisement manipulation KW - diaphragm KW - hemidiaphragmatic paresis KW - interscalene brachial plexus block KW - local anesthetic KW - phrenic nerve KW - ultrasonography KW - Arthroscopic shoulder surgery SP - 507 EP - 515 JF - Pain physician JO - Pain Physician VL - 24 IS - 8 N2 - BACKGROUND: An interscalene brachial plexus block is a commonly conducted nerve block for anesthesia and analgesia in shoulder surgery. Due to its proximity to the targeted nerve, the phrenic nerve, which innervates the diaphragm, is typically inadvertently blocked by ventral spread of the local anesthetic. Although hemidiaphragmatic paresis is tolerable in healthy patients, it would be an irreversible risk to patients with compromised lung reserve. OBJECTIVES: To investigate the effect of interscalene brachial plexus block on hemidiaphragmatic paresis by comparing the conventional local anesthetic volume with a reduced experimental volume at a more specific position using an ultrasound-guided 2-point injection technique. STUDY DESIGN: Prospective, randomized controlled study registered with the Clinical Trial Registry of Korea (https://cris.nih.go.kr/cris/index.jsp. KCT0005575. 04/11/2020). SETTING: This study was conducted at a single hospital affiliated with an academic institution between April and December 2020. METHODS: Patients undergoing brisement manipulation and arthroscopic shoulder surgery were randomized to the experimental (10 mL of ropivacaine 0.5%) and control groups (15 mL of ropivacaine 0.5%). Fifty-two patients who received an interscalene brachial plexus block for anesthesia and analgesia in the shoulder region. The interscalene block was performed using a 2-point injection and observing the spread pattern of the local anesthetic. The primary outcome was the incidence of hemidiaphragmatic paresis, estimated by the thickening fraction of the diaphragm. The secondary outcomes included oxygen saturation, presence of dyspnea, resting pain score, and handgrip strength score. RESULTS: Thickening fraction was significantly decreased in the control group compared with the experimental group (median [interquartile range], 13.9 [10.0-18.5] versus 28.5 [14.5-38.8], P < 0.001). The incidence of hemidiaphragmatic paresis was significantly higher in the control group than in the experimental group (92.3% versus 53.8%, P = 0.004). Handgrip strength was significantly reduced in the control group compared with the experimental group (P = 0.029). LIMITATIONS: We did not perform a phrenic nerve conduction study, as it is rarely performed in routine clinical operations. We did not formally assess the distance and spatial relationship of the phrenic nerve to the targeted nerve. Outcome variables including pain assessment were limited to the immediate postoperative period. CONCLUSIONS: Reducing the local anesthetic volume by selective injection and observing the spread pattern resulted in a decreased incidence of hemidiaphragmatic paresis and preserved handgrip strength after interscalene block. SN - 2150-1149 UR - https://www.unboundmedicine.com/medline/citation/34793637/Hemidiaphragmatic_Paresis_Following_Interscalene_Brachial_Plexus_Block_With_2_Point_Injection_Technique_ L2 - http://www.painphysicianjournal.com/linkout?issn=1533-3159&amp;vol=24&amp;page=507 DB - PRIME DP - Unbound Medicine ER -