Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?

Chaudhuri, Souvik; Gopalkrishna,; Paul, Cherish; Kundu, Ratul

doi:10.4103/0970-9185.94912

Cited by 4 publications

(6 citation statements)

References 10 publications

(14 reference statements)

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“…However, the block was exclusively used in elbow, forearm, wrist, and hand surgery. Case studies by Erickson and Chaudhuri et al report that also here hemidiaphragmatic paresis cannot always be avoided [ 17 , 18 ]. Erickson published a surgical study, however, without any detailed data concerning the anesthesiologic technique or the injected volume.…”

Section: Discussionmentioning

confidence: 99%

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection

et al. 2015

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BackgroundInterscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function.MethodsThis was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block.Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test.ResultsThe spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p <0.001, Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported.ConclusionA different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients.Trial registrationGerman Clinical Trials Register (DRKS number 00009908, registered 26 January 2016).

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Section: Discussionmentioning

confidence: 99%

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection

et al. 2015

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“…[3] It is a known complication of brachial plexus nerve blocks, especially with interscalene and supraclavicular approaches. [4] Unilateral or bilateral phrenic nerve palsies can occur as a part of neurological diseases such as critical illness polyneuropathy, Guillain–Barre syndrome, Charcot–Marie–Tooth disease. Infectious causes include pneumonia, viral infections such as herpes zoster involvement of the cervical nerve roots.…”

Section: Discussionmentioning

confidence: 99%

“…[2] Rare cases of bronchospasm associated with phrenic nerve palsy have been reported in literature. [4] There can be elevation in the arterial carbon dioxide tension seen particularly in the supine position, with more severe worsening when such patients are asleep. [10] Patients can have morning headaches, confusion and may also develop signs of cor pulmonale in this setting.…”

Section: Discussionmentioning

confidence: 99%

Failing phrenics

Rafiq

Ijaz²,

Tariq³

et al. 2016

Medicine

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Introduction:Idiopathic phrenic nerve palsy is a rare cause of exertional dyspnea. We present a case of a patient presenting with worsening dyspnea of an unknown etiology found to be related to bilateral phrenic nerve palsy.Discussion:Forty-two-year-old man presented to our emergency department with exertional dyspnea, orthopnea, and a left lower lobe consolidation treated initially as bronchitis by his primary physician as an outpatient, then subsequently as pneumonia at another institution, with no improvement in symptomatology. After admission to our hospital, CT chest demonstrated only supradiaphragmatic atelectatic changes. Echocardiography was normal. Bronchoscopy was contemplated however the patient could not lie flat. A fluoroscopic sniff test demonstrated diaphragmatic dysfunction and pulmonary function tests revealed restrictive pulmonary disease with evidence of neuromuscular etiology. Nerve conduction studies confirmed bilateral phrenic neuropathy. He was referred to a specialized neuromuscular disease center where subsequent workup did not demonstrate any specific etiology. A sleep study confirmed sleep disordered breathing suggestive of diaphragmatic paralysis and he was discharged on bi-level positive pressure ventilation.Conclusion:This is a unique case of exertional dyspnea and orthopnea from diaphragmatic paresis caused by bilateral phrenic nerve palsy where the initial workup for pulmonary and cardiovascular etiologies was essentially unremarkable. Shortness of breath and orthopnea caused by phrenic neuropathy is a rare condition, yet has a variety of etiologies. Our case suggests a template to the diagnostic approach, management, and follow up of bilateral phrenic nerve palsy.

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“…As the sign of initiation of successful inter scalene block is the "Horner syndrome" which is sooner than the onset of a sensory blockade. However, few cases were reported symptomatic phrenic nerve palsy with supraclavicular route also [5,6]. Recently the ultrasound guided block has been practiced frequently for surgical anesthesia with more precise block of nerves with reduced doses of local anesthetic.…”

Section: Discussionmentioning

confidence: 99%

Hypercarbia Induced Severe Bronchospasm and Unconsciousness Following Supraclavicular Block

Haleem¹

2016

Austin J Anesthesia and Analgesia

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Though the popularity of brachial plexus block for upper limb surgery is well known fact, but, one must not forget the complications associated with it. Herein, we report a middle aged obese female with fracture olecranon and proximal end of radius was posted for tension band wiring of olecranon process under ultrasound guided supraclavicular brachial plexus block. She was a known case of chronic obstructive pulmonary disease (COPD), with severe lung fibrosis and collapse, pleural thickening and mediastinal shift to the same side where she had to be operated. After repeated referral for optimization to tuberculosis and respiratory diseases she was posted for surgery after explaining the high risk involved to the patient. Following completion of procedure, she turned supine from lateral decubitus position, found unconscious and tachypnoeic. On auscultation, there was severe bronchospasm/silent chest; was immediately intubated and managed with difficulty.

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Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?

Cited by 4 publications

References 10 publications

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection

Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection

Failing phrenics

Hypercarbia Induced Severe Bronchospasm and Unconsciousness Following Supraclavicular Block

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