Urmey W F, Talts K H, Sharrock N E
Department of Anesthesiology, Hospital for Special Surgery, Cornell University Medical College, New York, New York 10021.
Anesth Analg. 1991 Apr;72(4):498-503. doi: 10.1213/00000539-199104000-00014.
Interscalene brachial plexus anesthesia for shoulder surgery routinely includes sensory anesthesia of the fourth and fifth cervical nerves. The authors reasoned that some degree of diaphragm paralysis should result from interscalene blocks that produce surgical C3-C5 sensory anesthesia. In this investigation, ultrasonography was used to study the incidence of ipsilateral hemidiaphragmatic paresis during routine interscalene block, as it is a practical, sensitive, and low-risk method for diagnosing hemidiaphragmatic function without radiation exposure. Thirteen healthy patients received interscalene blocks using a paresthesia technique with 34-52 mL 1.5% mepivacaine with added epinephrine and bicarbonate. All developed cervical sensory anesthesia. Data were collected before and 2, 5, and 10 min after injection, and, when possible (11 of 13 patients), at hourly intervals after surgery. Changes from normal to paradoxical motion of the ipsilateral hemidiaphragm were seen in all 13 patients during sniff and Mueller maneuvers within 5 min (in 11 of 13 patients at 2 min). Diaphragmatic motion returned to normal in 10 of 11 patients between 3 and 4 h after injection and in the remaining patient by the fifth hour after injection. Diaphragmatic paresis appears to be an inevitable consequence of interscalene brachial plexus block when providing anesthesia sufficient for shoulder surgery.
用于肩部手术的肌间沟臂丛神经麻醉通常包括对颈4和颈5神经的感觉麻醉。作者推断，产生手术所需C3 - C5感觉麻醉的肌间沟阻滞应会导致一定程度的膈肌麻痹。在本研究中，超声检查用于研究常规肌间沟阻滞期间同侧半膈肌麻痹的发生率，因为它是一种实用、敏感且无辐射暴露风险的诊断半膈肌功能的方法。13名健康患者采用异感技术接受肌间沟阻滞，使用34 - 52 mL含肾上腺素和碳酸氢钠的1.5%甲哌卡因。所有患者均出现颈部感觉麻醉。在注射前、注射后2、5和10分钟收集数据，并且在可能的情况下（13名患者中的11名），在术后每小时收集一次数据。在5分钟内，所有13名患者在嗅气和米勒动作时均出现同侧半膈肌从正常运动变为矛盾运动（13名患者中的11名在2分钟时出现）。11名患者中有10名在注射后3至4小时膈肌运动恢复正常，其余患者在注射后第五小时恢复正常。当提供足以进行肩部手术的麻醉时，膈肌麻痹似乎是肌间沟臂丛神经阻滞不可避免的后果。
