Cervical Spine Disease Is a Risk Factor for Persistent Phrenic Nerve Paresis Following Interscalene Nerve Block

Pakala, Swetha; Beckman, James D.; Lyman, Stephen; Zayas, Victor M.

doi:10.1097/aap.0b013e318289e922

Cited by 31 publications

(22 citation statements)

References 26 publications

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“…[17][18][19] The use of lower volumes of local anesthetic in ultrasound-guided interscalene block has been shown to reduce, but not eliminate, the incidence of phrenic nerve palsy. 3,4 This is not surprising given that the phrenic nerve lies within 2 mm Fig.…”

Section: Discussionmentioning

confidence: 99%

Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach

Laurent

Chan

Chin

2014

Can J Anesth/J Can Anesth

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Section: Discussionmentioning

confidence: 99%

Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach

Laurent

Chan

Chin

2014

Can J Anesth/J Can Anesth

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“…[6–8] The incidence of persistent HDP following ISB for shoulder surgery is of 1 per 2069 (0.048%). [9] …”

Section: Discussionmentioning

confidence: 99%

“…A recent study reported that symptomatic cervical spine disease was a risk factor of persistent HDP following ISB. [9] …”

Section: Discussionmentioning

confidence: 99%

Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block

et al. 2016

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Interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery. One of the disadvantages of this technique is the risk of hemidiaphragmatic paresis, which can occur as a result of phrenic nerve block and can cause a decrease in the pulmonary function, limiting the use of the block in patients with reduced functional residual capacity or a preexisting pulmonary disease. However, it is generally transient and is resolved over the duration of the local anesthetic's action.We present a case of a patient who experienced prolonged hemidiaphragmatic paresis following a continuous interscalene brachial plexus block for the postoperative pain management of shoulder surgery, and suggest a mechanism that may have led to this adverse effect.Nerve injuries associated with peripheral nerve blocks may be caused by several mechanisms. Our findings suggest that perioperative nerve injuries can occur as a result of combined mechanical and chemical injuries.

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“…4 Sympatholysis and antagonism of N-methyl-D-aspartate receptors in the central nervous system may be also responsible for the intraoperative analgesic effect of magnesium. 5 The administration of magnesium sulphate also results in potentiation of the effects of neuromuscular blocking agents, mainly through inhibition of acetylcholine release at motor nerve terminals. 4 -7 The change in the balance between acetylcholine and rocuronium in the synaptic cleft results in the deepening of NMB.…”

mentioning

confidence: 99%

Prolonged diaphragm dysfunction after interscalene brachial plexus block and shoulder surgery: a prospective observational pilot study

Jules-Elysée

Reid

Kahn

et al. 2014

British Journal of Anaesthesia

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NMB, or recurrent upper airway obstruction in the postoperative period.The stress response during airway management is potentially dangerous in obese patients with increased cardiovascular risk. 3 The mean arterial pressure and plasma norepinephrine levels increase significantly after tracheal intubation and extubation in obese patients. 3 Magnesium has been used to attenuate the cardiovascular response during airway management. 4 This effect is probably secondary to a reduction in the release of catecholamines from the adrenal medulla and adrenergic nerve terminals after sympathetic stimulation. 4 Sympatholysis, vasodilatation, improved contractility, limitation of infarct size, reduced frequency of arrhythmias, and coagulation modification are all effects that may be involved in the potential cardioprotection of magnesium. 4 Sympatholysis and antagonism of N-methyl-D-aspartate receptors in the central nervous system may be also responsible for the intraoperative analgesic effect of magnesium. 5 The administration of magnesium sulphate also results in potentiation of the effects of neuromuscular blocking agents, mainly through inhibition of acetylcholine release at motor nerve terminals. 4 -7 The change in the balance between acetylcholine and rocuronium in the synaptic cleft results in the deepening of NMB. 1 4 7 Even if sugammadex did not bind magnesium by encapsulation in microcalorimetric experiments, more sugammadex is suggested to overcome the new level of NMB. 1 In fact, after raising the magnesium concentration of the buffer from 3.5 to 4.07 mmol litre 21 (resulting in a decrease in twitch height to 65% of baseline value), much higher concentrations of sugammadex were required to reverse the block in the experimental setting. 1 Moreover, increasing the dose of sugammadex may also reduce the risk of recurrence of NMB if magnesium sulphate is given after operation. 1 6 It was found that magnesium caused only a small decrease in twitch height (to 72% of baseline twitch height) in the presence of sugammadex concentrations ranging from 5.6 to 19 mmol litre 21 , which represents the effect of magnesium alone. 1 In conclusion, sugammadex should be administered according to the level of NMB observed at accelerographic monitoring in the setting of magnesium sulphate administration in order to have a quick, safe, and effective reversal of rocuronium-induced NMB in morbidly obese patients. . Preclinical pharmacology of sugammadex. J Crit Care 2009; 24: 29-35 2 Carron M, Guzzinati S, Ori C. Simplified estimation of ideal and lean body weights in morbidly obese patients. Br J Anaesth 2012; 109: 829-30 3 Carron M, Veronese S, Gomiero W, et al. Hemodynamic and hormonal stress responses to endotracheal tube and ProSeal Laryngeal Mask Airway TM for laparoscopic gastric banding. Anesthesiology 2012; 117: 309-20 4 Fawcett WJ, Haxby EJ, Male DA. Magnesium: physiology and pharmacology. Br J Anaesth 1999; 83: 302-20 5 Elsharnouby NM, Elsharnouby MM. Magnesium sulphate as a technique of hypotensive anaesthesia. Br J Anae...

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Cervical Spine Disease Is a Risk Factor for Persistent Phrenic Nerve Paresis Following Interscalene Nerve Block

Cited by 31 publications

References 26 publications

Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach

Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach

Prolonged hemidiaphragmatic paresis following continuous interscalene brachial plexus block

Prolonged diaphragm dysfunction after interscalene brachial plexus block and shoulder surgery: a prospective observational pilot study

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