An attempt to prevent spread of local anaesthetic to the phrenic nerve by compression above the injection site during the interscalene brachial plexus block.
The brachial plexus was identified by electrical stimulation before interscalene block with 30 mL 0.5% bupivacaine and adrenaline 1:200,000. During injection, compression was applied with a finger proximal to the injection site. Spirometric measurements were made before the block, and then at 5 min, 10 min, 20 min and 4 h after the injection. Diaphragmatic excursion was measured radiographically before the block, and at 15 min and 4 h afterwards. In 25 patients studied, spirometric measurements decreased. Twenty minutes after the injection, the forced vital capacity was 27% less, forced expiratory volume at 1 s 34% less and peak expiratory flow rate 15% less (all P < 0.05). Right diaphragmatic excursion decreased from 4.5 cm (SD 1.2 cm) to 1.8 cm (0.6 cm) at 15 mins and to 1.1 cm (0.6 cm) at 4 h (P < 0.05). Identification of the plexus by electric stimulation combined with finger compression above the injection site did not prevent diaphragmatic paresis.
Département d'Anesthésie-Réanimation Chirurgicale I, Hôpital Roger Salengro (Hôpital B), Lille, France.
S E
SE
Bennani
F
F
Vandenabele-Teneur
J B
JB
Nyarwaya
M
M
Delecroix
R
R
Krivosic-Horber
D000322:Adrenergic Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D001917:Brachial Plexus / Q000502:physiology; D002045:Bupivacaine / Q000008:administration & dosage* / Q000009:adverse effects; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000187:drug effects; D004558:Electric Stimulation; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000294:innervation*; D009407:Nerve Block / Q000009:adverse effects; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D010791:Phrenic Nerve / Q000187:drug effects*; D011312:Pressure; D011859:Radiography; D012133:Respiratory Paralysis / Q000139:chemically induced; D013147:Spirometry; D014797:Vital Capacity / Q000187:drug effects
D000322:Adrenergic Agonists; D000779:Anesthetics, Local; D002045:Bupivacaine; D004837:Epinephrine