Hemidiaphragmatic paresis may occur in patients undergoing upper extremity surgery with supraclavicular block regardless of local anesthesia volume, according to results.
Hannah Lin
Hannah Lin, MD, and colleagues evaluated anesthetic dose levels that ranged from 5 cc to 35 cc in 21 patients undergoing right upper extremity surgery with supraclavicular block. Researchers prepared a mixture of mepivacaine 1.5% and bupivacaine 0.5% in 5-mL increments to be administered during supraclavicular block, beginning with a 35-mL dose in the first three patients. If no patients experienced hemidiaphragmatic paresis, the next three patients received 40 mL of the mepivacaine and bupivacaine mixture. However, the following group of three patients would receive the next-lowest dose if any of the three patients in the previous group exhibited hemidiaphragmatic paresis. Researchers stopped enrollment either when hemidiaphragmatic paresis occurred at the lowest dose or when six patients exhibited no hemidiaphragmatic paresis at a given dose.
Researchers used a bedside negative inspiratory force meter to monitor patient respiratory function at baseline and at 30 minutes after administration of supraclavicular block. Researchers also assessed motor and sensory function at 15 minutes and 30 minutes post-block.
Results showed patients experienced hemidiaphragmatic paresis at all anesthetic dose levels tested, with hemidiaphragmatic paresis occurring in 14 patients. Researchers found a statistically significant decrease in negative inspiratory force at 30 minutes post-block in patients with hemidiaphragmatic paresis. Researchers identified some dyspnea 30 minutes post-block in five patients with hemidiaphragmatic paresis. Oxygen saturation had a statistically significant decrease at 30 minutes post-block among patients with hemidiaphragmatic paresis, according to results. Respiratory intervention was not required for any patient, results showed. Researchers noted ineffective combined block scores among three of 21 patients at 30 minutes post-block.
“Even the smallest volume of local anesthetic could cause paresis of the diaphragm on the side getting the supraclavicular block,” Lin, who received the Best of Meeting Abstract Award for the study, told Healio Orthopedics. “In our study, while the paresis was not clinically relevant and did not require respiratory intervention, it may impact patients with underlying respiratory disease or diaphragmatic impairments.” – by Casey Tingle
Reference:
Lin H, et al. Abstract 714. Presented at: Regional Anesthesia and Acute Pain Medicine Annual Meeting; April 23-25, 2020 (meeting canceled).
Disclosure: Lin reports no relevant financial disclosures.
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Hemidiaphragmatic paresis may occur regardless of local anesthesia volume - Healio
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