Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block

Kang, RyungA; Chung, Yang Hoon; Ko, Justin Sangwook; Yang, Moon Sik; Choi, Duck Hwan

doi:10.1097/aap.0000000000000795

Cited by 22 publications

(34 citation statements)

References 24 publications

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“…Ipsilateral diaphragmatic excursion was assessed using ultrasound imaging before (baseline) and 30 min after block completion in all patients by a single anesthesiologist (R.A.K.) who was experienced in the technique 12 and who was blinded to group allocation. Diaphragmatic excursion was assessed using M-mode ultrasonography with the patient in the sitting position.…”

Section: Assessment Of Diaphragmatic Movement and Pulmonary Functionmentioning

confidence: 99%

“…13 Overall, we considered hemidiaphragmatic paresis to be present if partial or complete paresis occurred. 12 Pulmonary function was evaluated before and 30 min after block completion using a bedside spirometer (COPd-6, Vitalograph, Ireland) with the patient in the sitting position. The forced expiratory volume at 1 s and forced expiratory volume at 6 s were measured three times, and the values were averaged.…”

Section: Assessment Of Diaphragmatic Movement and Pulmonary Functionmentioning

confidence: 99%

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Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

et al. 2019

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Background: Interscalene brachial plexus block of the C5-C6 roots provides highly effective postoperative analgesia after shoulder surgery but usually results in hemidiaphragmatic paresis. Injection around the superior trunk of the brachial plexus is an alternative technique that may reduce this risk. The authors hypothesized that the superior trunk block would provide noninferior postoperative analgesia compared with the interscalene block and reduce hemidiaphragmatic paresis. Methods: Eighty patients undergoing arthroscopic shoulder surgery were randomized to receive a preoperative injection of 15 ml of 0.5% ropivacaine and 5 μg • ml −1 epinephrine around either (1) the C5-C6 nerve roots (interscalene block group) or (2) the superior trunk (superior trunk block group). The primary outcome was pain intensity 24 h after surgery measured on an 11-point numerical rating score; the prespecified noninferiority limit was 1. Diaphragmatic function was assessed using both ultrasonographic measurement of excursion and incentive spirometry by a blinded investigator before and 30 min after block completion. Results: Seventy-eight patients completed the study. The pain score 24 h postoperatively (means ± SDs) was 1.4 ± 1.0 versus 1.2 ± 1.0 in the superior trunk block (n = 38) and interscalene block (n = 40) groups, respectively. The mean difference in pain scores was 0.1 (95% CI, −0.3 to 0.6), and the upper limit of the 95% CI was lower than the prespecified noninferiority limit. Analgesic requirements and all other pain measurements were similar between groups. Hemidiaphragmatic paresis was observed in 97.5% of the interscalene block group versus 76.3% of the superior trunk block group (P = 0.006); paresis was complete in 72.5% versus 5.3% of the patients, respectively. The decrease in spirometry values from baseline was significantly greater in the interscalene block group. conclusions: The superior trunk block provided noninferior analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.

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Section: Assessment Of Diaphragmatic Movement and Pulmonary Functionmentioning

confidence: 99%

Section: Assessment Of Diaphragmatic Movement and Pulmonary Functionmentioning

confidence: 99%

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

et al. 2019

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“…Hemidiaphragmatic impairment might be reduced by the more difficult posterior approach to the suprascapular nerve . All participants had reduced hemidiaphragmatic excursion 30 min after interscalene block, the rate of which might be reduced by injecting 5 ml of local anaesthetic, rather than 20 ml, or by injecting above the clavicle or extrafascially .…”

Section: Discussionmentioning

confidence: 91%

“…Hemidiaphragmatic impairment might be reduced by the more difficult posterior approach to the suprascapular nerve [4]. All participants had reduced hemidiaphragmatic excursion 30 min after interscalene block, the rate of which might be reduced by injecting 5 ml of local anaesthetic, rather than 20 ml, or by injecting above the clavicle or extrafascially [10,[15][16][17]. Participants had less rest pain at two postoperative hours after interscalene block than after shoulder block, but more pain 22 h later, although morphine consumption was similar.…”

Section: Discussionmentioning

confidence: 99%

A randomised controlled trial of shoulder block vs. interscalene brachial plexus block for ventilatory function after shoulder arthroscopy

et al. 2019

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Summary The shoulder block may impair ventilatory function and diaphragmatic movement less than the interscalene brachial plexus block. We randomly allocated 30 adults who underwent shoulder arthroscopy under general anaesthesia to ultrasound‐guided shoulder block or interscalene block with 20 ml bupivacaine 0.5%. The primary outcome, rate of ultrasound‐measured hemidiaphragmatic excursion < 25% of baseline 30 min after blockade, was reduced from 12/15 with brachial plexus block to 2/15 with shoulder block, a difference (95%CI) of 67% (40–93%), p < 0.001. The mean (SD) numeric rating scale pain scores at rest after shoulder block were higher than after interscalene block at two postoperative hours, 1.4 (1.2) vs. 0.3 (0.7), p = 0.02, but lower at 24 postoperative hours, 1.3 (1.3) vs. 3.4 (2.3), p = 0.008. Mean (SD) pain scores on movement in the shoulder and interscalene blocks were similar, with respective values of 1.9 (1.9) vs. 0.7 (1.2), p = 0.13 at two postoperative hours and 3.7 (2.3) vs. 5.3 (2.5), p = 0.41, at 24 postoperative hours.

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“…Phrenic nerve blockade may occur resulting in hemidiaphragmatic paresis in up to 30% of patients. This can be limited by depositing the majority of injectate at the intersection of the first rib and subclavian artery 4 . The technique is usually reserved for in-patient use and best avoided in patients with significant respiratory dysfunction.…”

Section: Limitations and Complicationsmentioning

confidence: 99%

Upper limb nerve blocks

Raju¹,

Bowness²

2019

Anaesthesia & Intensive Care Medicine

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Brachial plexus blockade is used for a variety of upper limb surgical procedures. Ultrasound guidance is generally considered to be the gold-standard technique, although large-scale studies examining efficacy and complications of ultrasound-guided techniques compared with nerve stimulation are still needed. Interscalene block remains the approach of choice for shoulder surgery, although phrenic nerve blockade is common even using low volumes of local anaesthetic. Of the currently available studies comparing the other approaches, there seems to be little difference in efficacy between axillary, supraclavicular and infraclavicular approaches for elbow, forearm and hand surgery when equivalent levels of expertise are used. The major features influencing block choice and performance are discussed.

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Reduced Hemidiaphragmatic Paresis With a “Corner Pocket” Technique for Supraclavicular Brachial Plexus Block

Abstract: This study was registered at Clinical Trial Registry of Korea, identifier KCT0001769.

Cited by 22 publications

References 24 publications

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery

A randomised controlled trial of shoulder block vs. interscalene brachial plexus block for ventilatory function after shoulder arthroscopy

Upper limb nerve blocks

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