The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study

  • Oh, Chahyun (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University) ;
  • Noh, Chan (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Eom, Hongsik (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Lee, Sangmin (Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital) ;
  • Park, Seyeon (College of Nursing, Chungnam National University) ;
  • Lee, Sunyeul (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University) ;
  • Shin, Yong Sup (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University) ;
  • Ko, Youngkwon (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University) ;
  • Chung, Woosuk (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University) ;
  • Hong, Boohwi (Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University)
  • Received : 2019.08.23
  • Accepted : 2020.01.20
  • Published : 2020.04.01
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Abstract

Background: Hemidiaphragmatic paralysis, a frequent complication of the brachial plexus block performed above the clavicle, is rarely associated with an infraclavicular approach. The costoclavicular brachial plexus block is emerging as a promising infraclavicular approach. However, it may increase the risk of hemidiaphragmatic paralysis because the proximity to the phrenic nerve is greater than in the classical infraclavicular approach. Methods: This retrospective analysis compared the incidence of hemidiaphragmatic paralysis in patients undergoing costoclavicular and supraclavicular brachial plexus blocks. Of 315 patients who underwent brachial plexus block performed by a single anesthesiologist, 118 underwent costoclavicular, and 197 underwent supraclavicular brachial plexus block. Propensity score matching selected 118 pairs of patients. The primary outcome was the incidence of hemidiaphragmatic paralysis, defined as a postoperative elevation of the hemidiaphragm > 20 mm. Factors affecting the incidence of hemidiaphragmatic paralysis were also evaluated. Results: Hemidiaphragmatic paralysis was observed in three patients (2.5%) who underwent costoclavicular and 47 (39.8%) who underwent supraclavicular brachial plexus blocks (P < 0.001; odds ratio, 0.04; 95% confidence interval, 0.01-0.13). Both the brachial plexus block approach and the injected volume of local anesthetic were significantly associated with hemidiaphragmatic paralysis. Conclusions: The incidence of hemidiaphragmatic paralysis is significantly lower with costoclavicular than with supraclavicular brachial plexus block.

Keywords

References

  1. Kang RA, Chung YH, Ko JS, Yang MK, Choi DH. Reduced hemidiaphragmatic paresis with a "corner pocket" technique for supraclavicular brachial plexus block: singlecenter, observer-blinded, randomized controlled trial. Reg Anesth Pain Med 2018; 43: 720-4.
  2. Mak PH, Irwin MG, Ooi CG, Chow BF. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia 2001; 56: 352-6. https://doi.org/10.1046/j.1365-2044.2001.01708-2.x
  3. Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth 2008; 101: 549-56. https://doi.org/10.1093/bja/aen229
  4. Sinha SK, Abrams JH, Barnett JT, Muller JG, Lahiri B, Bernstein BA, et al. Decreasing the local anesthetic volume from 20 to 10 mL for ultrasound-guided interscalene block at the cricoid level does not reduce the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med 2011; 36: 17-20. https://doi.org/10.1097/AAP.0b013e3182030648
  5. Stundner O, Meissnitzer M, Brummett CM, Moser S, Forstner R, Kokofer A, et al. Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trial. Br J Anaesth 2016; 116: 405-12. https://doi.org/10.1093/bja/aev550
  6. Lee JH, Cho SH, Kim SH, Chae WS, Jin HC, Lee JS, et al. Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL. Can J Anaesth 2011; 58: 1001-6. https://doi.org/10.1007/s12630-011-9568-5
  7. Ryu TH, Jeon YH, Lim DG. Postoperative analgesia in dyspneic patient after interscalene brachial plexus block with general anesthesia: a case report. J Korean Pain Soc 2004; 17: 266-70. https://doi.org/10.3344/jkps.2004.17.2.266
  8. 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 2009; 34: 595-9. https://doi.org/10.1097/AAP.0b013e3181bfbd83
  9. Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesth Analg 1992; 74: 352-7.
  10. Sotthisopha T, Elgueta MF, Samerchua A, Leurcharusmee P, Tiyaprasertkul W, Gordon A, et al. Minimum effective volume of lidocaine for ultrasound-guided costoclavicular block. Reg Anesth Pain Med 2017; 42: 571-4. https://doi.org/10.1097/AAP.0000000000000629
  11. Rose M, Ness TJ. Hypoxia following interscalene block. Reg Anesth Pain Med 2002; 27: 94-6. https://doi.org/10.1053/rapm.2002.29709
  12. Erickson JM, Louis DS, Naughton NN. Symptomatic phrenic nerve palsy after supraclavicular block in an obese man. Orthopedics 2009; 32: 368. https://doi.org/10.3928/01477447-20090501-02
  13. Gentili ME, Deleuze A, Estebe JP, Lebourg M, Ecoffey C. Severe respiratory failure after infraclavicular block with 0.75% ropivacaine: a case report. J Clin Anesth 2002; 14: 459-61. https://doi.org/10.1016/S0952-8180(02)00387-2
  14. Petrar SD, Seltenrich ME, Head SJ, Schwarz SK. Hemidiaphragmatic paralysis following ultrasound-guided supraclavicular versus infraclavicular brachial plexus blockade: a randomized clinical trial. Reg Anesth Pain Med 2015; 40: 133-8. https://doi.org/10.1097/AAP.0000000000000215
  15. Dullenkopf A, Blumenthal S, Theodorou P, Roos J, Perschak H, Borgeat A. Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block. Reg Anesth Pain Med 2004; 29: 110-4. https://doi.org/10.1016/j.rapm.2004.07.134
  16. Rodriguez J, Barcena M, Alvarez J. Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block. Reg Anesth Pain Med 2003; 28: 33-6. https://doi.org/10.1053/rapm.2003.50022
  17. Kessler J, Schafhalter-Zoppoth I, Gray AT. An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block. Reg Anesth Pain Med 2008; 33: 545-50. https://doi.org/10.1097/00115550-200811000-00006
  18. Songthamwat B, Karmakar MK, Li JW, Samy W, Mok LYH. Ultrasound-guided infraclavicular brachial plexus block: prospective randomized comparison of the lateral sagittal and costoclavicular approach. Reg Anesth Pain Med 2018; 43: 825-31.
  19. Li JW, Songthamwat B, Samy W, Sala-Blanch X, Karmakar MK. Ultrasound-guided costoclavicular brachial plexus block: sonoanatomy, technique, and block dynamics. Reg Anesth Pain Med 2017; 42: 233-40. https://doi.org/10.1097/AAP.0000000000000566
  20. Karmakar MK, Sala-Blanch X, Songthamwat B, Tsui BC. Benefits of the costoclavicular space for ultrasound-guided infraclavicular brachial plexus block: description of a costoclavicular approach. Reg Anesth Pain Med 2015; 40: 287-8. https://doi.org/10.1097/AAP.0000000000000232
  21. Sala-Blanch X, Reina MA, Pangthipampai P, Karmakar MK. Anatomic basis for brachial plexus block at the costoclavicular space: a cadaver anatomic study. Reg Anesth Pain Med 2016; 41: 387-91. https://doi.org/10.1097/AAP.0000000000000393
  22. Aliste J, Bravo D, Layera S, Fernandez D, Jara A, Maccioni C, et al. Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery. Reg Anesth Pain Med 2019. doi: 10.1136/rapm-2018-100055.
  23. Garcia-Vitoria C, Vizuete J, Lopez Navarro AM, Bosch M. Costoclavicular space: a reliable gate for continuous regional anesthesia catheter insertion. Anesthesiology 2017; 127: 712. https://doi.org/10.1097/ALN.0000000000001724
  24. Nieuwveld D, Mojica V, Herrera AE, Pomes J, Prats A, Sala-Blanch X. Medial approach of ultrasound-guided costoclavicular plexus block and its effects on regional perfussion. Rev Esp Anestesiol Reanim 2017; 64: 198-205. https://doi.org/10.1016/j.redar.2016.09.010
  25. Soares LG, Brull R, Lai J, Chan VW. Eight ball, corner pocket: the optimal needle position for ultrasound-guided supraclavicular block. Reg Anesth Pain Med 2007; 32: 94-5.
  26. Lee DK. An introduction to propensity score matching methods. Anesth Pain Med 2016; 11: 130-48. https://doi.org/10.17085/apm.2016.11.2.130
  27. Ho D, Imai K, King G, Stuart EA. MatchIt: nonparametric preprocessing for parametric causal inference. J Stat Softw 2011; 42: 28.
  28. Albrecht E, Bathory I, Fournier N, Jacot-Guillarmod A, Farron A, Brull R. Reduced hemidiaphragmatic paresis with extrafascial compared with conventional intrafascial tip placement for continuous interscalene brachial plexus block: a randomized, controlled, double-blind trial. Br J Anaesth 2017; 118: 586-92. https://doi.org/10.1093/bja/aex050
  29. Tran DQ, Elgueta MF, Aliste J, Finlayson RJ. Diaphragmsparing nerve blocks for shoulder surgery. Reg Anesth Pain Med 2017; 42: 32-8. https://doi.org/10.1097/AAP.0000000000000529
  30. Leurcharusmee P, Elgueta MF, Tiyaprasertkul W, Sotthisopha T, Samerchua A, Gordon A, et al. A randomized comparison between costoclavicular and paracoracoid ultrasoundguided infraclavicular block for upper limb surgery. Can J Anaesth 2017; 64: 617-25. https://doi.org/10.1007/s12630-017-0842-z
  31. El-Boghdadly K, Chin KJ, Chan VWS. Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations. Anesthesiology 2017; 127: 173-91. https://doi.org/10.1097/ALN.0000000000001668
  32. Aliste J, Bravo D, Fernandez D, Layera S, Finlayson RJ, Tran DQ. A randomized comparison between interscalene and small-volume supraclavicular blocks for arthroscopic shoulder surgery. Reg Anesth Pain Med 2018; 43: 590-5. https://doi.org/10.1097/aap.0000000000000767
  33. Demondion X, Herbinet P, Boutry N, Fontaine C, Francke JP, Cotten A. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol 2003; 24: 1303-9.
  34. Morimoto M, Popovic J, Kim JT, Kiamzon H, Rosenberg AD. Case series: septa can influence local anesthetic spread during infraclavicular brachial plexus blocks. Can J Anaesth 2007; 54: 1006-10. https://doi.org/10.1007/BF03016635
  35. Brenner D, Mahon P, Iohom G, Cronin M, O'Flynn C, Shorten G. Fascial layers influence the spread of injectate during ultrasound-guided infraclavicular brachial plexus block: a cadaver study. Br J Anaesth 2018; 121: 876-82. https://doi.org/10.1016/j.bja.2018.04.043
  36. Monzo E, Hadzic A. Costoclavicular approach to the brachial plexus block: simple or double injection? Reg Anesth Pain Med 2019. doi: 10.1136/rapm-2019-100852.
  37. Scott S, Fuld JP, Carter R, McEntegart M, MacFarlane NG. Diaphragm ultrasonography as an alternative to whole-body plethysmography in pulmonary function testing. J Ultrasound Med 2006; 25: 225-32. https://doi.org/10.7863/jum.2006.25.2.225
  38. Boussuges A, Gole Y, Blanc P. Diaphragmatic motion studied by m-mode ultrasonography: methods, reproducibility, and normal values. Chest 2009; 135: 391-400. https://doi.org/10.1378/chest.08-1541
  39. Testa A, Soldati G, Giannuzzi R, Berardi S, Portale G, Gentiloni Silveri N. Ultrasound M-mode assessment of diaphragmatic kinetics by anterior transverse scanning in healthy subjects. Ultrasound Med Biol 2011; 37: 44-52. https://doi.org/10.1016/j.ultrasmedbio.2010.10.004
  40. Wade OL, Gilson JC. The effect of posture on diaphragmatic movement and vital capacity in normal subjects with a note on spirometry as an aid in determining radiological chest volumes. Thorax 1951; 6: 103-26. https://doi.org/10.1136/thx.6.2.103
  41. Wade OL. Movements of the thoracic cage and diaphragm in respiration. J Physiol 1954; 124: 193-212. https://doi.org/10.1113/jphysiol.1954.sp005099
  42. Alexander C. Diaphragm movements and the diagnosis of diaphragmatic paralysis. Clin Radiol 1966; 17: 79-83. https://doi.org/10.1016/S0009-9260(66)80128-9
  43. Chetta A, Rehman AK, Moxham J, Carr DH, Polkey MI. Chest radiography cannot predict diaphragm function. Respir Med 2005; 99: 39-44. https://doi.org/10.1016/j.rmed.2004.04.016
  44. Lim CY, In J. Randomization in clinical studies. Korean J Anesthesiol 2019; 72: 221-32. https://doi.org/10.4097/kja.19049