Document Detail

Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis.
MedLine Citation:
PMID:  19920426     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Interscalene brachial plexus block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether an ultrasound (US)-guided interscalene brachial plexus block performed at the level of root C7 versus a nerve stimulation interscalene brachial plexus block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. METHODS: In a prospective randomized controlled trial, 30 patients scheduled for elective shoulder surgery under combined general anesthesia and interscalene brachial plexus block were included. Interscalene brachial plexus block using the same dose was performed using either US or nerve stimulation guidance of ropivacaine for both groups. General anesthesia was standardized. Ventilatory function was assessed using spirometry, and movement of the hemidiaphragm was assessed by US. RESULTS: Two patients in the US group showed complete paresis of the hemidiaphragm, but in the nerve stimulation group, 12 patients showed complete and 2 patients had partial paresis of the hemidiaphragm (13% versus 93%, respectively; P < 0.0001). Ventilatory function (forced expiratory volume at 1 second, forced vital capacity, and peak expiratory flow) was significantly reduced in the nerve stimulation group compared with the US-guided group (P < 0.05). One block failure occurred in the nerve stimulation group compared with none in the US group. No adverse effects occurred in either group. CONCLUSIONS: Ultrasound-guided interscalene brachial plexus block performed at the level of root C7 using 10 mL of ropivacaine 0.75% reduces the incidence of hemidiaphragmatic paresis.
Steven H Renes; Harald C Rettig; Mathieu J Gielen; Oliver H Wilder-Smith; Geert J van Geffen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Regional anesthesia and pain medicine     Volume:  34     ISSN:  1532-8651     ISO Abbreviation:  Reg Anesth Pain Med     Publication Date:    2009 Sep-Oct
Date Detail:
Created Date:  2009-11-20     Completed Date:  2010-01-27     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9804508     Medline TA:  Reg Anesth Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  498-502     Citation Subset:  IM    
Department of Anesthesiology, Radboud University Nijmegen Medical Centre, Ikazia Hospital Rotterdam, the Netherlands.
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MeSH Terms
Amides / adverse effects*
Anesthetics, Local / adverse effects*
Brachial Plexus / ultrasonography*
Diaphragm / innervation*,  physiopathology,  ultrasonography
Electric Stimulation
Forced Expiratory Volume
Middle Aged
Nerve Block* / adverse effects
Paresis / etiology,  physiopathology,  prevention & control*
Peak Expiratory Flow Rate
Phrenic Nerve / drug effects*
Prospective Studies
Shoulder / surgery
Time Factors
Ultrasonography, Interventional*
Vital Capacity
Young Adult
Reg. No./Substance:
0/Amides; 0/Anesthetics, Local; 84057-95-4/ropivacaine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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