Kowalski S E, Bradley B D, Greengrass R A, Freedman J, Younes M K
Department of Anesthesia, University of Manitoba, Winnipeg, Canada.
Anesth Analg. 1992 Sep;75(3):400-4. doi: 10.1213/00000539-199209000-00015.
Several authors have questioned the potential for phrenic nerve paralysis with interpleural analgesia. This study was designed to examine the potential for phrenic nerve paralysis with the use of interpleural bupivacaine in dogs. Seven dogs were anesthetized, tracheally intubated, and allowed to breathe spontaneously with halothane/oxygen while in the supine position. After a midline laparotomy, two wires were inserted into the costal portion of each hemidiaphragm for measurement of electromyographic (EMG) signals. A balloon catheter was placed in the abdominal cavity to measure abdominal pressure. The abdomen was then closed. Airway pressure was measured through a side port in the endotracheal tube. Bilateral interpleural catheters were inserted with the loss-of-resistance technique. Each dog was used for two experiments, one on each side, except for one animal. To assess the contribution of the ipsilateral diaphragm to total respiratory effort, the airway was occluded at functional residual capacity for three consecutive breaths, and EMG, airway pressure, and abdominal pressure were measured. In five of nine experiments with bupivacaine, there was complete loss of EMG activity on the side of the injection. In two dogs, there was partial loss of diaphragmatic function, and in the remaining two, there was no change in EMG. In the normal saline solution group (n = 4), there was no change in the EMG. Two dogs that received bilateral bupivacaine injections developed paradoxical respiration with negative inspiratory intraabdominal pressures. Phrenic nerve paralysis or paresis can occur with interpleural blockade. The factors affecting the occurrence of this complication remain to be elucidated.
几位作者对肋间神经阻滞导致膈神经麻痹的可能性提出了质疑。本研究旨在探讨在犬类中使用肋间布比卡因导致膈神经麻痹的可能性。七只犬麻醉后气管插管，仰卧位时吸入氟烷/氧气自主呼吸。经中线剖腹手术后，在每个半膈肌的肋部插入两根导线以测量肌电图（EMG）信号。将球囊导管置于腹腔内测量腹压。然后关闭腹腔。通过气管内导管的侧孔测量气道压力。采用阻力消失法插入双侧肋间导管。每只犬用于两个实验，除一只动物外，每侧各进行一个实验。为评估同侧膈肌对总呼吸功的贡献，在功能残气量时连续三次阻断气道，同时测量EMG、气道压力和腹压。在九次布比卡因实验中的五次，注射侧的EMG活动完全消失。两只犬出现部分膈肌功能丧失，其余两只犬的EMG无变化。在生理盐水组（n = 4）中，EMG无变化。两只接受双侧布比卡因注射的犬出现反常呼吸，吸气时腹内压为负。肋间神经阻滞可导致膈神经麻痹或轻瘫。影响该并发症发生的因素尚待阐明。
