Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study

Detalhes bibliográficos
Autor(a) principal: Ferré,Fabrice
Data de Publicação: 2019
Outros Autores: Mastantuono,Jean-Mathieu, Martin,Charlotte, Ferrier,Anne, Marty,Philippe, Laumonerie,Pierre, Bonnevialle,Nicolas, Minville,Vincent
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Revista Brasileira de Anestesiologia (Online)
Texto Completo: http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942019000600580
Resumo: Abstract Background and objectives: The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block. Methods: Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the “corner pocket”. Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed. Results: Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale numerical rating scale (NRS) at 24 hours did not differ between groups. Conclusions: Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function.
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spelling Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort studyRegional anesthesiaPhrenic nerveDiaphragmatic paralysisAnestesia regionalNervo frênicoParalisia diafragmáticaAbstract Background and objectives: The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block. Methods: Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the “corner pocket”. Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed. Results: Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale numerical rating scale (NRS) at 24 hours did not differ between groups. Conclusions: Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function.Sociedade Brasileira de Anestesiologia2019-12-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersiontext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942019000600580Revista Brasileira de Anestesiologia v.69 n.6 2019reponame:Revista Brasileira de Anestesiologia (Online)instname:Sociedade Brasileira de Anestesiologia (SBA)instacron:SBA10.1016/j.bjane.2019.10.005info:eu-repo/semantics/openAccessFerré,FabriceMastantuono,Jean-MathieuMartin,CharlotteFerrier,AnneMarty,PhilippeLaumonerie,PierreBonnevialle,NicolasMinville,Vincenteng2020-02-05T00:00:00Zoai:scielo:S0034-70942019000600580Revistahttps://www.sbahq.org/revista/https://old.scielo.br/oai/scielo-oai.php||sba2000@openlink.com.br1806-907X0034-7094opendoar:2020-02-05T00:00Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)false
dc.title.none.fl_str_mv Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
title Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
spellingShingle Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
Ferré,Fabrice
Regional anesthesia
Phrenic nerve
Diaphragmatic paralysis
Anestesia regional
Nervo frênico
Paralisia diafragmática
title_short Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
title_full Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
title_fullStr Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
title_full_unstemmed Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
title_sort Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a prospective cohort study
author Ferré,Fabrice
author_facet Ferré,Fabrice
Mastantuono,Jean-Mathieu
Martin,Charlotte
Ferrier,Anne
Marty,Philippe
Laumonerie,Pierre
Bonnevialle,Nicolas
Minville,Vincent
author_role author
author2 Mastantuono,Jean-Mathieu
Martin,Charlotte
Ferrier,Anne
Marty,Philippe
Laumonerie,Pierre
Bonnevialle,Nicolas
Minville,Vincent
author2_role author
author
author
author
author
author
author
dc.contributor.author.fl_str_mv Ferré,Fabrice
Mastantuono,Jean-Mathieu
Martin,Charlotte
Ferrier,Anne
Marty,Philippe
Laumonerie,Pierre
Bonnevialle,Nicolas
Minville,Vincent
dc.subject.por.fl_str_mv Regional anesthesia
Phrenic nerve
Diaphragmatic paralysis
Anestesia regional
Nervo frênico
Paralisia diafragmática
topic Regional anesthesia
Phrenic nerve
Diaphragmatic paralysis
Anestesia regional
Nervo frênico
Paralisia diafragmática
description Abstract Background and objectives: The frequent onset of hemidiaphragmatic paralysis during interscalene block restricts its use in patients with respiratory insufficiency. Supraclavicular block could be a safe and effective alternative. Our primary objective was to assess the incidence of hemidiaphragmatic paralysis following ultrasound-guided supraclavicular block and compare it to that of interscalene block. Methods: Adults warranting elective shoulder surgery under regional anesthesia (Toulouse University Hospital) were prospectively enrolled from May 2016 to May 2017 in this observational study. Twenty millilitres of 0.375% Ropivacaine were injected preferentially targeted to the “corner pocket”. Diaphragmatic excursion was measured by ultrasonography before and 30 minutes after regional anesthesia. A reduction ≥25% in diaphragmatic excursion during a sniff test defined the hemidiaphragmatic paralysis. Dyspnoea and hypoxaemia were recorded in the recovery room. Predictive factors of hemidiaphragmatic paralysis (gender, age, weight, smoking, functional capacity) were explored. Postoperative pain was also analysed. Results: Forty-two and 43 patients from respectively the supraclavicular block and interscalene block groups were analysed. The incidence of hemidiaphragmatic paralysis was 59.5% in the supraclavicular block group compared to 95.3% in the interscalene block group (p < 0.0001). Paradoxical movement of the diaphragm was more common in the interscalene block group (RR = 2, 95% CI 1.4-3; p = 0.0001). A similar variation in oxygen saturation was recorded between patients with and without hemidiaphragmatic paralysis (p = 0.08). No predictive factor of hemidiaphragmatic paralysis could be identified. Morphine consumption and the highest numerical rating scale numerical rating scale (NRS) at 24 hours did not differ between groups. Conclusions: Given the frequent incidence of hemidiaphragmatic paralysis following supraclavicular block, this technique cannot be recommended for patients with an altered respiratory function.
publishDate 2019
dc.date.none.fl_str_mv 2019-12-01
dc.type.driver.fl_str_mv info:eu-repo/semantics/article
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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status_str publishedVersion
dc.identifier.uri.fl_str_mv http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0034-70942019000600580
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dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 10.1016/j.bjane.2019.10.005
dc.rights.driver.fl_str_mv info:eu-repo/semantics/openAccess
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dc.format.none.fl_str_mv text/html
dc.publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
publisher.none.fl_str_mv Sociedade Brasileira de Anestesiologia
dc.source.none.fl_str_mv Revista Brasileira de Anestesiologia v.69 n.6 2019
reponame:Revista Brasileira de Anestesiologia (Online)
instname:Sociedade Brasileira de Anestesiologia (SBA)
instacron:SBA
instname_str Sociedade Brasileira de Anestesiologia (SBA)
instacron_str SBA
institution SBA
reponame_str Revista Brasileira de Anestesiologia (Online)
collection Revista Brasileira de Anestesiologia (Online)
repository.name.fl_str_mv Revista Brasileira de Anestesiologia (Online) - Sociedade Brasileira de Anestesiologia (SBA)
repository.mail.fl_str_mv ||sba2000@openlink.com.br
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