Incidence of Diaphragmatic Paralysis Secondary to Supraclavicular Brachial Plexus Blockade Measured by Ultrasound in a Fourth Level Institution
Abstract
Introduction. Regional anesthesia is an important, innovative, and popular technique for anesthetic and painkiller management. In supraclavicular brachial plexus blockade, there is a 50-60% rate of diaphragmatic paralysis. Clinical presentation is variable according to the patient’s internal and external factors. There are multiple radiological techniques in diagnosis, with ultrasounds being very useful due to their easy access. The objective is to determine the incidence of diaphragmatic paralysis secondary to supraclavicular brachial plexus blockade guided by ultrasound in a fourth level institution. Methodology. Prospective, longitudinal, analytical study. 110 patients were selected. Inclusion criteria: patients over 18 years of age subject to upper limb surgery with supraclavicular brachial plexus blockade. Exclusion criteria: ASA (American Society of Anesthesiologists) 4 and 5 patients, pregnant women BMI >35 kg/m2 patients with neuromuscular background, restrictive or obstructive pulmonary disease, phrenic nerve paralysis, or diaphragmatic dysfunction. An analysis was carried out via statistical tests, describing the different degrees of diaphragmatic paralysis. Results. In patients who met the inclusion criteria, the incidence of diaphragmatic paralysis was 65% (37% with total and 28% with partial paralysis), 1.81% showed respiratory symptoms without hemodynamic changes. Discussion. Supraclavicular brachial plexus blockade is a technique related to diaphragmatic paralysis. Ultrasound has allowed for the incidence of this complication to be reduced. It is a useful method in post-operative diagnosis. Conclusions. Diaphragmatic paralysis after supraclavicular brachial plexus blockade is a complication mainly observed in patients with previous pulmonary problems. Therefore, it must be strictly monitored.
References
Casas-Arroyave FD, Ramírez-Mendoza E, Ocampo-Agudelo AF. Complications associated to three brachial plexus blocking techniques: Systematic review and
meta-analysis. Rev Esp Anestesiol Reanim. [Internet]. 2021;(68)392-407. doi: https://doi.org/10.1016/j.redar.2020.10.005
Koscielniak-Nielsen ZJ, Dahl JB. Ultrasound-guided peripheral nerve blockade of the upper extremity. Curr Opin Anaesthesiol. [Internet]. 2012;25(2):253-259. doi:
https://doi.org/10.1097/ACO.0b013e32835069c2
Mian A, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: A review of the relevant anatomy, complications, and anatomical variations. Clin Anat. [Internet]. 2014;27(2):210-221. doi: https://doi.org/10.1002/ca.22254
Omoregbe OR, Idehen HO, Imarengiaye CO. Supraclavicular Brachial Plexus Block for Upper Limb Fracture Fixation:A Comparison of Nerve Stimulation,
Ultrasound-Guided Technique and a Combination of both Techniques. West Afr J Med [Internet]. 2020;37(7):757-762. Recuperado a partir de: https://pubmed.ncbi.nlm.nih.gov/33296484/
Mak PH, Irwin MG, Ooi CG, Chow BF. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary
function. Anaesthesia [Internet]. 2001;56:350-369. doi:
https://doi.org/10.1046/j.1365-2044.2001.01708-2.x
Ferré F, Mastantuono JM, Martin C, Ferrier A, Marty P, Laumonerie P, et al. Hemidiaphragmatic paralysis after ultrasound-guided supraclavicular block: a
prospective cohort study. Rev Bras Anestesiol [Internet]. 2019;69(6):580-586. doi: https://doi.org/10.1016/j.bjane.2019.10.005
Bonilla-Ramírez AJ, Grueso-Angulo E, Peñate-Suárez EE. Parálisis diafragmática secundaria a bloqueo de plexo braquial vía infraclavicular para cirugía de miembro superior. Rev. Colomb. Anestesiol [Internet]. 2011;39(4):589-594. doi: https://doi.org/10.5554/rca.v39i4.269
Angulo RG, Ramírez AJ, Oliveros MM, Hoyos AS, Gómez VW, Herrera MA, et al. Evaluación de la motilidad diafragmática por ultrasonido en pacientes llevados a cirugía ortopédica de miembro superior bajo anestesia regional utilizando bloqueo infraclavicular. Univ Méd [Internet]. 2016;57(2):155-62. doi: http://dx.doi.org/10.11144/Javeriana.umed57-2.emdu
O’Toole SM, Kramer J. Unilateral Diaphragmatic Paralysis. StatPearls [Internet]. 2022. Recuperado a partir de: https://www.ncbi.nlm.nih.gov/books/NBK557388/
Laghi FA, Saad M, Shaikh H. Ultrasound and nonultrasoundimaging techniques in the assessment of diaphragmatic dysfunction. BMC Pulm Med [Internet]. 2021;21(85). doi: https://doi.org/10.1186/s12890-021-01441-6
Oliver-Fornies P, Ortega JP, Gómez E, Pellicer G, Gutiérrez O, Cabeza V, et al. Diaphragmatic paralysis, respiratory function, and postoperative pain after interscalene brachial plexus block with a reduced doce of 10 ml levobupivacaine 0.25% versus a 20 ml dose in patients undergoing arthroscopic shoulder surgery: study protocol fot the randomized controlled double-blind REDOLEV study. Trials [Internet]. 2021;22(287). doi: https://doi.org/10.1186/s13063-021-05216-6
Baskaralingam A, Nicod L, Manzoni R. Parésies et paralysies diaphragmatiques. Rev Med Suisse [Internet]. 2020;16(705):1646-1651. doi: https://doi.org/10.53738/REVMED.2020.16.705.1646
Zhang L, Pang R, Zhang L. Effect of different volumes of 0.375% ropivacaine on diaphragmatic paralysis by supraclavicular brachial plexus block under ultrasound
guidance. Ann Palliat Med [Internet]. 2020;9(6):3993-4001. doi: https://doi.org/10.21037/apm-20-1955
Shauli CC, Arish N, Rokach A, Jarjoui A, Izbicki G. [DIAPHRAGMATICPARALYSIS]. Harefuah [Internet]. 2021;160(3):144-147. Recuperado a partir de: https://pubmed.ncbi.nlm.nih.gov/33749175/
Ricoy J, Rodríguez-Núñez N, Álvarez-Dobaño JM, Toubes ME, Riveiro V, Valdés L. Diaphragmatic dysfunction. Pulmonol [Internet]. 2019;25(4):223-235 doi: https://doi.org/10.1016/j.pulmoe.2018.10.008
Boussuges A, Rives S, Finance J, Brégeon F. Assessment of diaphragmatic function by ultrasonography: Current approach and perspectives. World J Clin Cases [Internet]. 2020;8(12):2408-2424. doi: https://doi.org/10.12998/wjcc.v8.i12.2408
Zaragoza-Lemus G, Limón-Munoz M, García-Reyes W. Ultrasonographic assessment of hemidiaphragm paralysis secondary to interscalene block. Cir Cir
[Internet]. 2012;80(4):352-356. Recuperado a partir de: https://www.medigraphic.com/cgi-bin/new/resumenI.cgi?IDARTICULO=36748
Richard P. Exploration du diaphragme: l’échographie est incontournable. Rev Mal Respir [Internet]. 2017;34(6):645-660. doi: https://doi.org/10.1016/j.rmr.2017.02.005
Kilaru D, Panebianco N, Baston C. Diaphragm Ultrasound in Weaning From Mechanical Ventilation. Chest. [Internet]. 2021;159(3):1166-1172. doi: https://doi.org/10.1016/j.chest.2020.12.003
Hamadah HK, Kabbani MS, Elbarbary M, Hijazi O, Shaath G, et al. Ultrasound for diaphragmatic dysfunction in postoperative cardiac children. Cardiol Young [Internet]. 2017;27(3):452-458. doi: https://doi.org/10.1017/S1047951116000718
Nason LK, Walker CM, McNeeley MF, Burivong W, Fligner CL, Godwin JD. Imaging of the diaphragm: Anatomy and function. Radiographics [Internet]. 2012;32(2):E51-E70. doi: https://doi.org/10.1148/rg.322115127
Gerard-Castaing N, Perrin T, Ohlmann C, Mainguy C, Coutier L, Buchs C, et al. Diaphragmatic paralysis in young children: A literature review. Pediatr Pulmonol
[Internet]. 2019;54(9):1367-1373. doi: https://doi.org/10.1002/ppul.24383
Mak P, Irwin M, Ooi C, Chow B. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia [Internet]. 2001;56(4):352-356. doi: https://doi.org/10.1046/j.1365-2044.2001.01708-2.x
Renes SH, Spoormans HH, Gielen MJ, Rettig HC, van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med [Internet]. 2009;34(6):595-599. doi: https://doi.org/10.1097/aap.0b013e3181bfbd83
Petrar SD, Seltenrich ME, Head SJ, Schwarz SK. Hemidiaphragmatic paralysis following ultrasoundguided supraclavicular versus infraclavicular brachial
plexus blockade: A randomized clinical trial. Reg Anesth Pain Med [Internet]. 2015;40(2):133-138. doi: https://doi.org/10.1097/AAP.0000000000000215
Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by M-Mode Ultrasonography: Methods, Reproducibility, and Normal Values. CHEST [Internet].
;135(2):391-400. doi: https://doi.org/10.1378/chest.08-1541
Sarwal A, Walker FO, Cartwright MS. Neuromuscular ultrasound for evaluation of the diaphragm. Muscle Nerve [Internet]. 2013;47(3):319-329. doi: https://doi.org/10.1002/mus.23671
Knoblanche GE. The incidence and Aetiology of Phrenic Nerve Blockade Associated with Supraclavicular Brachial Plexus Block. Anaesth Intens
Care [Internet]. 1979;7(4):346-349. doi: https://doi.org/10.1177/0310057X7900700406
Downloads
Copyright (c) 2022 MedUNAB
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
