Phrenic nerve palsy following coracoid infraclavicular brachial plexus block

Lee, Hong Sik; Lee, Jae Hak; Deog, Young; Park, Soo Young; Seo, Chu Hwan; Han, Jeong Uk

doi:10.4097/kjae.2009.57.4.515

Cited by 5 publications

(6 citation statements)

References 10 publications

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“…18 As hemidiaphragmatic paralysis following infraclavicular blockade has been reported to be rare even following traditional techniques, 8,30 we assumed the incidence to be in the order of 1%. On this basis, to detect a 32% decrease relative to supraclavicular blockade at α = 0.05 (1-tailed), the minimum required sample size was 16 per group to achieve 90% power and 20 per group to achieve 95% power (StatMate version 2.00; GraphPad, San Diego, California).…”

Section: Sample Size Projectionmentioning

confidence: 99%

“…[2][3][4][5] The incidence of PNP has been reported to be as high as 100% following interscalene brachial plexus block 6 and 50% to 67% following supraclavicular block. 7 While PNP is generally considered rare following infraclavicular block, 5,8,9 the incidence prior to the widespread adoption of ultrasound-guided regional anesthesia using solely landmark-based or nerve-stimulator techniques has been reported as high as 26%. 10 The comparative incidence of PNP associated with contemporary ultrasound-guided infraclavicular blockade, particularly relative to supraclavicular blockade, has received little dedicated study.…”

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confidence: 99%

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Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade

Petrar

Seltenrich

Head

et al. 2015

Regional Anesthesia and Pain Medicine

150

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Ultrasound-guided supraclavicular blockade with 30 mL of 0.5% ropivacaine produced complete hemidiaphragmatic paralysis in approximately one-third of patients. The infraclavicular approach greatly reduced this risk but did not eliminate it. These data may aid in the selection of the approach to brachial plexus blockade, particularly in ambulatory patients and/or those with respiratory comorbidities.

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Section: Sample Size Projectionmentioning

confidence: 99%

mentioning

confidence: 99%

Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade

Petrar

Seltenrich

Head

et al. 2015

Regional Anesthesia and Pain Medicine

150

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“…Higher volumes of local anesthetic, e.g., 40 mLs combined with 0.5% bupivacaine, may cause phrenic nerve paresis in some patients following this type of block. 4 Typically, a high volume of local anesthetic is the most associated factor with clinically significant postoperative dyspnea after an infraclavicular block. No dyspnea related to the anesthesia occurred in either of the cases in this report, nor was there any decrease in oxygen saturation post-operatively or at time of discharge.…”

Section: Discussionmentioning

confidence: 99%

Bilateral infraclavicular brachial plexus nerve blocks in an ambulatory surgery center

et al. 2022

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The approach for upper extremity surgery brachial plexus blocks depends on the specific nature of the surgery. Interscalene and supraclavicular brachial plexus blocks can cause phrenic nerve palsy. Our aim was to explore the safety of bilateral parasagittal infraclavicular brachial plexus blocks (BPBBs) in an outpatient surgery center. Identical BPBBs were performed in two patients with 20 mL of 0.25% bupivacaine. Neither patient developed respiratory or cardiovascular distress. Brachial plexus blocks on multiple locations are infrequently employed for fear of phrenic nerve paresis. However, given both patients’ success, bilateral parasagittal infraclavicular brachial plexus blocks may provide a safe approach. Keywords: Nerve block, brachial plexus blocks, phrenic nerve, anesthesia, pain

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“…Both supraclavicular and infraclavicular brachial plexus blockades can potentially result in diaphragmatic paralysis (Bigeleisen, 2003;Lee et al, 2009). The proximally located interscalene block is expected to cause hemi-diaphragmatic paralysis since the classic C3-C4-C5 PN roots are in close proximity (Lanz, Theiss, & Jankovic, 1983;Bigeleisen, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Regional anesthetic techniques are also plagued with ramifications from PN and APN involvement. Both supraclavicular and infraclavicular brachial plexus blocks can either anesthetize or inflict trauma on the APN (Bigeleisen, ; Lee et al ).…”

Section: Introductionmentioning

confidence: 99%

Origin and prevalence of the accessory phrenic nerve: A meta‐analysis and clinical appraisal

et al. 2017

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The accessory phrenic nerve (APN) is a common anatomical variant with differing reports of prevalence in the literature. It can be injured during operative procedures to the neck and thorax or by regional anesthetic techniques in its vicinity. Our aim was to provide a comprehensive evidence-based assessment of the prevalence and origins of the APN. The databases PubMed, China National Knowledge Infrastructure, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science were searched comprehensively, followed by assessment of eligibility and extraction of data concerning the APN. The data were pooled into a meta-analysis. A total of 17 studies were included in the meta-analysis. Fourteen studies (n = 1,941 hemi-necks) reported data on APN prevalence resulting in an overall pooled prevalence estimate of 36.5%. Nine studies (n = 941 APNs) reported data on the origin of the APN. Most commonly the APN originated from the ansa cervicalis (16.5%) followed by the nerve to the subclavius (15.8%). Subgroup analysis on the basis of laterality and geographic region revealed no statistically significant findings. The APN is a highly variable anatomical structure present in over one third of the population, most often originating from the ansa cervicalis or the nerve to the subclavius. Clinicians need to be aware of the varying constellation of symptoms that can arise from APN injury. Ultimately, knowledge of APN variation could provide for better outcomes and reduction of iatrogenic injuries, particularly in high-risk patients prone to long-term complications from diaphragmatic dysfunction. Clin. Anat. 30:1077-1082, 2017. © 2017 Wiley Periodicals, Inc.

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Phrenic nerve palsy following coracoid infraclavicular brachial plexus block

Cited by 5 publications

References 10 publications

Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade

Hemidiaphragmatic Paralysis Following Ultrasound-Guided Supraclavicular Versus Infraclavicular Brachial Plexus Blockade

Bilateral infraclavicular brachial plexus nerve blocks in an ambulatory surgery center

Origin and prevalence of the accessory phrenic nerve: A meta‐analysis and clinical appraisal

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