title: Phrenic nerve block caused by interscalene brachial plexus block: breathing effects of different sites of injection.
abstract: Interscalene brachial plexus (ISB) block is often associated with phrenic nerve block and diaphragmatic paresis. The goal of our study was to test if the anterior or the posterior ultrasound guided approach of the ISB is associated with a lower incidence of phrenic nerve blocks and impaired lung function.
  
  
  
  This was a prospective, randomized and single-blinded study of 84 patients scheduled for elective shoulder surgery who fullfilled the inclusion and exclusion critereria. Patients were randomized in two groups to receive either the anterior (n = 42) or the posterior (n = 42) approach for ISB. Clinical data were recorded. In both groups patients received ISB with a total injection volume of 15 ml of ropivacaine 1 %. Spirometry was conducted at baseline (T0) and 30 min (T30) after accomplishing the block. Changes in spirometrical variables between T0 and T30 were investigated by Wilcoxon signed-rank test for each puncture approach. The temporal difference between the posterior and the anterior puncture approach groups were again analyzed by the Wilcoxon-Mann-Whitney test.
  
  
  
  The spirometric results showed a significant decrease in vital capacity, forced expiratory volume per second, and maximum nasal inspiratory breathing after the Interscalene brachial plexus block; indicating a phrenic nerve block (p <0.001, Wilcoxon signed-rank). A significant difference in the development of the spirometric parameters between the anterior and the posterior group could not be identified (Wilcoxon-Mann-Whitney test). Despite the changes in spirometry, no cases of dyspnea were reported.
  
  
  
  A different site of injection (anterior or posterior) did not show an effect in reducing the cervical block spread of the local anesthetic and the incidence of phrenic nerve blocks during during ultrasound guided Interscalene brachial plexus block. Clinical breathing effects of phrenic nerve blocks are, however, usually well compensated, and subjective dyspnea did not occur in our patients.
  
  
  
  German Clinical Trials Register (DRKS number 00009908 , registered 26 January 2016).
authors.affiliation: Klinik fϋr Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bochum Langendreer, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany. Lars.Bergmann@kk-bochum.de.
authors.forename: Lars
authors.identifier: 0000-0002-8603-8549
authors.initials: L
authors.lastname: Bergmann
authors.affiliation: Klinik fϋr Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bochum Langendreer, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Martini
authors.affiliation: Clinical Epidemiology, Integrated Research and Treatment Center - Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kesselmeier
authors.affiliation: Klinik fϋr Anästhesiologie, Intensivmedizin und Schmerztherapie, Evangelisches Krankenhaus Unna, Unna, Germany.
authors.forename: Wolf
authors.initials: W
authors.lastname: Armbruster
authors.affiliation: Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Tϋbingen, Tϋbingen, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Notheisen
authors.affiliation: Klinik fϋr Anästhesiologie, Intensivmedizin und Schmerztherapie, Knappschaftskrankenhaus Bochum Langendreer, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Adamzik
authors.affiliation: Abteilung für Anästhesiologie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Tϋbingen, Tϋbingen, Germany.
authors.forename: Rϋdiger
authors.initials: R
authors.lastname: Eichholz
mesh_terms: D000328:Adult; D000577:Amides; D000779:Anesthetics, Local / Q000008:administration & dosage*; D065527:Brachial Plexus Block / Q000379:methods*; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000379:methods*; D010791:Phrenic Nerve; D011446:Prospective Studies; D000077212:Ropivacaine; D016037:Single-Blind Method; D013147:Spirometry; D018709:Statistics, Nonparametric; D018084:Ultrasonography, Interventional / Q000379:methods; D014797:Vital Capacity
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
keywords: Breathing effects; Injections site; Interscalene block; Phrenic nerve