title: The importance of phrenic nerve preservation and its effect on long-term postoperative lung function after pneumonectomy.
abstract: OBJECTIVE
  The importance of phrenic nerve preservation during pneumonectomy remains controversial. We previously demonstrated that preservation of the phrenic nerve in the immediate postoperative period preserved lung function by 3-5% but little is known about its long-term effects. We, therefore, decided to investigate the effect of temporary ipsilateral cervical phrenic nerve block on dynamic lung volumes in mid- to long-term pneumonectomy patients.
  
  
  METHODS
  We investigated 14 patients after a median of 9 years post pneumonectomy (range: 1-15 years). Lung function testing (spirometry) and fluoroscopic and/or sonographic assessment of diaphragmatic motion on the pneumonectomy side were performed before and after ultrasonographic-guided ipsilateral cervical phrenic nerve block by infiltration with lidocaine.
  
  
  RESULTS
  Ipsilateral phrenic nerve block was successfully achieved in 12 patients (86%). In the remaining 2 patients, diaphragmatic motion was already paradoxical before the nerve block. We found no significant difference on dynamic lung function values (FEV1 'before' 1.39 ± 0.44 vs FEV1 'after' 1.38 ± 0.40; P = 0.81).
  
  
  CONCLUSIONS
  Induction of a temporary diaphragmatic palsy did not significantly influence dynamic lung volumes in mid- to long-term pneumonectomy patients, suggesting that preservation of the phrenic nerve is of greater importance in the immediate postoperative period after pneumonectomy.
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark Division of General Thoracic Surgery, University Hospital of Bern, Bern, Switzerland gregor.kocher@insel.ch.
authors.forename: Gregor J
authors.initials: GJ
authors.lastname: Kocher
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Jannie Lysgaard
authors.initials: JL
authors.lastname: Poulson
authors.affiliation: Department of Anesthesia, Odense University Hospital, Odense, Denmark.
authors.forename: Morten Rune
authors.initials: MR
authors.lastname: Blichfeldt-Eckhardt
authors.affiliation: Department of Radiology, Odense University Hospital, Odense, Denmark.
authors.forename: Bo
authors.initials: B
authors.lastname: Elle
authors.affiliation: Division of General Thoracic Surgery, University Hospital of Bern, Bern, Switzerland.
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Schmid
authors.affiliation: Department of Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Licht
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D059351:Organ Sparing Treatments / Q000009:adverse effects*; D010791:Phrenic Nerve / Q000293:injuries*; D011013:Pneumonectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000517:prevention & control*
keywords: Diaphragm; Lung cancer; Phrenic nerve; Pneumonectomy; Pulmonary function