title: The effects of cervical epidural anesthesia with bupivacaine on pulmonary function in conscious patients.
abstract: Cervical epidural anesthesia (CEA) can affect diaphragmatic function. We investigated the effects of CEA on the diaphragm muscle performance, breathing pattern, and respiratory drive of 10 healthy patients undergoing hand surgery before and after the administration of 0.25% and 0.375% bupivacaine. The lung volumes and flows, respiratory rate (RR), minute ventilation, respiratory cycle time, occlusion pressure, maximal inspiratory pressure (MIP), and hand grip strength were determined. ETCO2 and SpO2 were continuously monitored. The diaphragmatic excursion was evaluated using ultrasonography. Although CEA allowed painless hand rehabilitation, both 0.25% and 0.375% bupivacaine impaired diaphragmatic excursion, with values decreasing from 5.6 to 4.4 and 3.3 cm (P < 0.05), respectively, during forced sniff maneuvers. In the 0.25% and 0.375% bupivacaine groups, the values of MIP decreased from 74 to 56 and 44 cm H2O, forced vital capacity decreased from 3.8 to 3.2 and 2.8 L, and hand grip strength decreased from 43.3 to 27.8 and 20.5 kg force, respectively (P < 0.05). The tidal volume decreased from 0.8 to 0.6 and 0.5 L in the 0.25% and 0.375% bupivacaine groups, respectively, the RR increased from 14 to 18 breaths/min in both groups, and the occlusion pressure increased from 1.5 to 2.1 and 2.9 cm H2O in the 0.25% and 0.375% bupivacaine groups, respectively (P < 0.05). ETCO2 increased from 35.2 to 38.1 and 39.3 mm Hg in the 0.25% and 0.375% bupivacaine groups, respectively, and SpO2 decreased by 2% +/- 1% in the 0.375% bupivacaine group. CEA affects diaphragmatic function and the resulting lung volumes and MIP values. The observed alterations in breathing pattern and the significant increase in ventilatory drive may be caused by changes in the diaphragmatic muscle tension and an augmented CO2 load. In conclusion, we do not recommend this technique for routine postoperative hand rehabilitation using the studied bupivacaine concentrations.
  
  
  CONCLUSIONS
  We studied cervical epidural anesthesia in healthy patients undergoing hand surgery. The technique allowed painless rehabilitation but affected breathing pattern, diaphragmatic function, and respiratory drive. We cannot recommend this technique for routine clinical use.
authors.affiliation: Department of Anesthesiology, Lapeyronie University Hospital, Montpellier, France.
authors.forename: X
authors.initials: X
authors.lastname: Capdevila
authors.forename: P
authors.initials: P
authors.lastname: Biboulet
authors.forename: J
authors.initials: J
authors.lastname: Rubenovitch
authors.forename: O
authors.initials: O
authors.lastname: Serre-Cousine
authors.forename: P
authors.initials: P
authors.lastname: Peray
authors.forename: J
authors.initials: J
authors.lastname: Deschodt
authors.forename: F
authors.initials: F
authors.lastname: d'Athis
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000494:pharmacology*; D002045:Bupivacaine / Q000494:pharmacology*; D003964:Diaphragm / Q000187:drug effects / Q000502:physiology; D005260:Female; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012119:Respiration / Q000187:drug effects
chemical_list: D000779:Anesthetics, Local; D002045:Bupivacaine