[Diaphragmatic excursion after inter-sternocleidomastoid block depending on the site of the injection].
OBJECTIVE
To evaluate the incidence of the hemidiaphragmatic paresis after inter Sterno-Cleido-Mastoid (inter-SCM) block.


METHODS
Prospective, comparative, single blind study.


METHODS
16 patients ASA I-II.


METHODS
The diaphragmatic paresis was measured by a radiologist unaware of the technique used and operated side. It was determined by the diaphragmatic excursion (DE) on double-exposure chest radiography, obtained preoperatively and postoperatively (DE-pre, DE-post) for the ipsilateral and controlateral side of the inter-SCM block. All the patients were given 20 mL 0.5% bupivacaine plus 20 mL 2% lidocaine both with epinephrine. These anesthetics were injected via the stimuling needle or via the catheter after opacified radiological control of the catheter position. The patients were divided into 2 groups. Group 1: injection via the needle after eliciting flexion of fingers, or via a catheter into infraclavicular position; group 2: injection via the needle after eliciting contraction of deltoid, or elbow flexion, or via a supraclavicular catheter.


RESULTS
All the patients had satisfactory block. The ipsilateral DE was decreased after injection of anesthetics in group 2 (P < 0.001) while it remained unchanged in group 1.


CONCLUSIONS
The diaphragmatic paresis is avoidable with the inter-SCM block if and only if the anesthetic solution is injected via the needle after stimulating flexion of fingers or via a catheter into infraclavicular position.
Petitfaux
F
F
Service d'anesthésie-réanimation chirurgicale, Hôtel-Dieu, Nantes, France.
Pham-Dang
C
C
Dupas
B
B
Camps
C
C
Blanche
E
E
Legendre
E
E
Pinaud
M
M
D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D001917:Brachial Plexus; D002045:Bupivacaine / Q000009:adverse effects; D005260:Female; D005385:Fingers; D006801:Humans; D007273:Injections, Intramuscular / Q000009:adverse effects / Q000379:methods*; D008012:Lidocaine / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles; D009407:Nerve Block / Q000009:adverse effects*; D010791:Phrenic Nerve / Q000293:injuries*; D011187:Posture; D011446:Prospective Studies; D012133:Respiratory Paralysis / Q000209:etiology* / Q000517:prevention & control; D016037:Single-Blind Method
D000779:Anesthetics, Local; D008012:Lidocaine; D002045:Bupivacaine