Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
Reg Anesth Pain Med. 2022 Mar;47(3):167-170. doi: 10.1136/rapm-2021-102962. Epub 2022 Jan 10.
The interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.
30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.
10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.
Although injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.
经斜角肌间臂丛阻滞已被有效地用于接受肩部手术的患者的术中及术后镇痛，但它与膈肌功能障碍的发生率高有关。在更高的位置（即上干水平）进行阻滞可能会降低膈神经麻痹的发生率。我们假设高位肌间沟阻滞将导致膈神经麻痹的发生率低于 20%。
30 例行关节镜肩部手术的患者在超声引导下接受高位肌间沟阻滞。在阻滞前、阻滞后 15 分钟以及麻醉后恢复室（PACU）二期，通过超声测量膈肌活动度，并结合呼吸功能的临床参数进行评估。
10 名患者（33.3%，95%置信区间 17.3%至 52.8%）在术后评估时出现完全性膈神经麻痹。另外 8 名患者（26.7%）出现不完全性麻痹。在出现膈神经效应的 18 名患者中，有 7 名（38.9%）报告有呼吸困难。膈神经运动异常的患者中有 83.3%（总样本的 56.7%）在听诊时呼吸音明显减弱。氧饱和度测量值与膈神经效应无相关性，在术后评估时也没有显著降低。
虽然与传统的肌间沟阻滞相比，在上干水平注射局部麻醉剂与膈神经麻痹的发生率较低有关，但仍有相当一部分患者会出现超声和临床证据的膈肌无力或麻痹。
