scholarly journals Interscalene Versus Supraclavicular Approach to Brachial Plexus Nerve Blockade and Local Anesthetic Volume Effect on the Incidence of Phrenic Nerve Dysfunction during Shoulder Surgery

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Ezz Hesham M ◽  
Dikstein Anna F ◽  
Rayaz Hassan ◽  
Mastrangelo Elissa ◽  
Medvecky Michael J ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Phrenic Nerve ◽  
Volume Effect ◽  
Shoulder Surgery ◽  
Nerve Blockade ◽  
Supraclavicular Approach ◽  
Nerve Dysfunction

scholarly journals The Incidence and Aetiology of Phrenic Nerve Blockade Associated with Supraclavicular Brachial Plexus Block

1979 ◽  
Vol 7 (4) ◽  
pp. 346-349 ◽  
Author(s):  
G. E. Knoblanche
Keyword(s):  
Brachial Plexus ◽  
Nerve Block ◽  
Phrenic Nerve ◽  
Brachial Plexus Block ◽  
X Ray ◽  
Supraclavicular Approach ◽  
True Incidence ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block ◽  
Phrenic Nerve Block

A trial to ascertain the true incidence of inadvertent phrenic nerve block with brachial plexus block via the supraclavicular approach was carried out. Phrenic nerve block was monitored by x-ray screening of the diaphragm. There was an incidence of phrenic nerve block of 67% (10 cases of diaphragmatic paralysis in 15 brachial blocks). The possible causes of phrenic nerve block with brachial block are discussed. It is concluded that the phrenic nerve is blocked peripherally in front of the scalenus anterior.

scholarly journals Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Jason K. Panchamia ◽  
David A. Olsen ◽  
Adam W. Amundson
Keyword(s):  
Case Report ◽  
Pain Management ◽  
Brachial Plexus ◽  
Nerve Block ◽  
Phrenic Nerve ◽  
Brachial Plexus Block ◽  
Shoulder Surgery ◽  
Anesthetic Technique ◽  
Infraclavicular Brachial Plexus Block ◽  
Plexus Block

Background. Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report. We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion. This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management.

Diaphragmatic height index: new diagnostic test for phrenic nerve dysfunction

2012 ◽  
Vol 117 (5) ◽  
pp. 890-896 ◽  
Author(s):  
Chaturong Pornrattanamaneewong ◽  
Roongsak Limthongthang ◽  
Torpon Vathana ◽  
Kamolporn Kaewpornsawan ◽  
Panupan Songcharoen ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Nerve Injury ◽  
Diagnostic Test ◽  
Phrenic Nerve ◽  
Brachial Plexus Injury ◽  
Nerve Function ◽  
Phrenic Nerve Injury ◽  
Nerve Dysfunction ◽  
The Difference ◽  
Group B

Object The diaphragmatic height index (DHI) was developed to measure the difference in diaphragm levels. The purpose of this study was to set definite DHI values and test the accuracy of these values for use as a new diagnostic test for phrenic nerve dysfunction. Methods All data for this study were obtained from medical charts and retrospectively reviewed. Results One hundred sixty-five patients with brachial plexus injury who had undergone nerve transfers between 2005 and 2008 were divided into Groups A and B. Group A consisted of 40 patients (mean age 28.0 years) who had sustained concomitant injury of the brachial plexus and phrenic nerves. Patients in Group A1 had right phrenic nerve injury and those in Group A2 had left phrenic nerve injury. Intraoperative direct electrical stimulation of the phrenic nerve was considered the gold standard in assessing nerve function in all patients with brachial plexus injury. Group B consisted of 125 patients (mean age 28.7 years) with brachial plexus injury and normal phrenic nerve function. Group C, the control group, consisted of 80 patients with nonbrachial plexus injury (mean age 34.0 years) who had undergone other kinds of orthopedic operations between April and June 2009. Standard posteroanterior chest radiographs were blindly interpreted using the Siriraj inhouse picture archiving and communication system in all 245 patients in the study. First, a reference line (R line) was drawn along the inferior endplate of T-10. Then, 2 lines (lines A and B) were drawn through the highest point of each diaphragm and parallel to the R line. The difference between these 2 lines divided by the height of T-10 was defined as the DHI. The cutoff points of the DHI for diagnosing right and left phrenic nerve dysfunction were analyzed with a receiver operating characteristic curve. The accuracy of these DHI values was then evaluated. The DHI in Group C was 0.64 ± 0.44, slightly higher than the DHI in Group B, with no significant difference. Diaphragmatic height indexes in Groups A1 and A2 were 2.0 ± 0.99 and −1.04 ± 0.83, respectively, which were significantly different from those in Groups B and C (p < 0.05). The cutoff point of the DHI for diagnosing right phrenic nerve dysfunction was > 1.1, and that for left phrenic nerve dysfunction was < 0.2. The sensitivity and specificity of right and left DHI values were 90.5% and 86.3%, and 94.7 and 88.3%, respectively. Conclusions Data in this study show that diaphragm paralysis can be simply and reliably predicted by the DHI. Diaphragmatic height index values > 1.1 and < 0.2 are proposed as the new diagnostic test for right and left phrenic nerve dysfunction with a high degree of accuracy. This index is applicable in diagnosing phrenic nerve dysfunction that occurs concomitantly with brachial plexus injury or from other etiologies.

Clinical effect of normal saline injectate into interscalene nerve block catheters given within one hour of local anesthetic bolus on analgesia and hemidiaphragmatic paralysis

2020 ◽  
pp. rapm-2020-101922
Author(s):  
Lynn Ngai Gerber ◽  
Lisa Y Sun ◽  
Wen Ma ◽  
Shruthi Basireddy ◽  
Nan Guo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Brachial Plexus ◽  
Nerve Block ◽  
Local Anesthetic ◽  
Normal Saline ◽  
Phrenic Nerve ◽  
Intervention Group ◽  
Pain Scores ◽  
Significant Difference ◽  
Interscalene Nerve Block

BackgroundPrevious case reports describe the reversal of phrenic nerve blockade from the interscalene nerve block using normal saline injectate washout. This randomized clinical trial aimed to evaluate whether using normal saline injectate to wash out local anesthetic from an interscalene nerve block catheter would restore phrenic nerve and diaphragm function, while preserving analgesia.MethodsInstitutional review board approval, clinical trial registration and consent were obtained for patients undergoing shoulder surgery with an interscalene nerve block catheter. 16 patients were randomized to receive three 10 mL aliquots of normal saline injectate (intervention group, n=8) or three sham injectates (control group, n=8) via their perineural catheters in the postanesthesia care unit (PACU). Primary outcome measures were the effects on ipsilateral hemidiaphragmatic paralysis, and secondary outcome measures included PACU opioid consumption, pain scores and change in brachial plexus sensory examination and motor function.ResultsThere was no significant difference in reversal of hemidiaphragmatic paralysis. However, there was a greater number of patients in the intervention group who ultimately displayed partial, as opposed to full, paralysis of the hemidiaphragm (p=0.03). There was no significant difference in pain scores, PACU opioid requirement, and brachial plexus motor and sensory examinations between the two groups.ConclusionsAll patients had persistent hemidiaphragmatic paralysis after the intervention, but fewer patients in the intervention group progressed to full paralysis, suggesting that a larger bolus dose of normal saline may be needed to completely reverse hemidiaphragmatic paralysis. Although normal saline injectate in 10mL increments given through the interscalene nerve block catheter had no clinically significant effect on reversing phrenic nerve blockade, it also did not lead to a reduction in analgesia and may be protective in preventing the progression to full hemidiaphragmatic paralysis.Trail registration numberNCT03677778.

scholarly journals Effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for arthroscopic shoulder surgery: a prospective observational study

2019 ◽  
Author(s):  
Byung-Gun Kim ◽  
Woojoo Lee ◽  
Hyunzu Kim ◽  
Chunwoo Yang ◽  
Yoon Sang Jeon ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Phrenic Nerve ◽  
Nerve Palsy ◽  
Brachial Plexus Block ◽  
Suprascapular Nerve ◽  
Shoulder Surgery ◽  
Phrenic Nerve Palsy ◽  
Interscalene Brachial Plexus Block ◽  
Arthroscopic Shoulder Surgery ◽  
Plexus Block

Abstract Background Although interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery, one major drawback of interscalene brachial plexus block is ipsilateral phrenic nerve palsy. Several diaphragm-sparing nerve blocks have been suggested. We prospectively evaluated the effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for postoperative analgesia following arthroscopic shoulder surgery.Methods Nineteen patients scheduled for arthroscopic shoulder surgery received combined ultrasound-guided suprascapular nerve and costoclavicular brachial plexus block. Pain scores, use of supplemental analgesia, incidence of phrenic nerve palsy, block-related outcomes, patient satisfaction, and adverse effects were assessed.Results The block was successful in 17 patients (89.5%). Postoperative pain control was effective during the first 24 h after surgery. Phrenic nerve palsy did not occur (0%, 95% confidential interval 0 – 17%). There were no severe adverse events. Patients reported a high degree of satisfaction.Conclusion Combined suprascapular nerve and costoclavicular brachial plexus block provided effective postoperative analgesia for arthroscopic shoulder surgery without causing phrenic nerve palsy.

scholarly journals Detection of neurovascular structures using injection pressure in blockade of brachial plexus in rat

2005 ◽  
Vol 5 (3) ◽  
pp. 79-85 ◽  
Author(s):  
Ilvana Vučković ◽  
Admir Hadžić ◽  
Faruk Dilberović ◽  
Amela Kulenović ◽  
Zakira Mornjaković ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Regional Anesthesia ◽  
Local Anesthetic ◽  
Injection Pressure ◽  
Medical Procedure ◽  
Intravascular Injection ◽  
Nerve Blockade ◽  
High Injection Pressure ◽  
Special Software ◽  
Neurovascular Structures

In the last few decades there has been a great development of regional anesthesia; all the postulates are defined and all the techniques of usage are perfected. However, like any other medical procedure, the block of brachial plexus carries a risk of certain unwanted complications, like possible intraneural and intravascular injections. The reason for great discrepancy between the injury of brachial plexus and other periphery nerves while performing the nerve blockade is the frequent usage of this block, but also the specific proximity of neurovascular structures in axilla. The purpose of this work is to determine the values of pressures which appear in paraneural, intraneural and intravascular injection applications of local anesthetic, and to compare those values in order to avoid cases of intraneural and in-travascular injections in clinical practice with consequential complications. In experimental study there have been used 12 Wistar rats of both genders. After anesthesia with ether and midhumeral access to the neurovascular structures in axilla, the injection of 2% lidocain with epinephrine was performed with the help of automatic syringe charger. The needle was at first placed paraneural, and then also intraneural and intravascular. During every application the pressure values were monitored using the manometer, and then they were analyzed by special software program. All paraneural injections resulted with the pressure between 13,96-27,92 kPa. The majority of intraneural injections were combined with the injection pressure greater than 69,8 kPa, while the intravascular injections were combined with injection pressure less than 6,98 kPa. Based on the available data it can be noticed that so far none of the methods of prevention from unwanted complications of regional anesthesia can insure the avoidance of intraneural and intravascular injection of local anesthetic. Based on our research it is obvious that the measuring of pressure during the nerve blockade is very important in order to decrease the risk of neurological and possible systematic complications. It is also clear that a small, mobile, and financially quite available apparatus for pressure measurement can help in differentiation between paraneural, intra-neural and intravascular injection. Avoiding high injection pressure prevents from lodging the needle into intraneural space, while avoiding a very low injection pressure prevents from lodging the needle into intravascular space followed by consequential complications. The usage of this apparatus can find its application in other blockades of periphery nerves, and in other branches of medicine as well.

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