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Costoclavicular brachial plexus block reduces hemidiaphragmatic paralysis more than supraclavicular brachial plexus block: retrospective, propensity score matched cohort study

Korean Journal of Pain 2020년 33권 2호 p.144 ~ 152
 ( Oh Cha-Hyun ) - Chungnam National University College of Medicine Department of Anesthesiology and Pain Medicine

노찬 ( Noh Chan ) - Chungnam National University Hospital Department of Anesthesiology and Pain Medicine
 ( Eom Hong-Sik ) - Chungnam National University Hospital Department of Anesthesiology and Pain Medicine
 ( Lee Sang-Min ) - Chungnam National University Hospital Department of Anesthesiology and Pain Medicine
 ( Park Se-Yeon ) - Chungnam National University College of Nursing
이선열 ( Lee Sun-Yeul ) - Chungnam National University Hospital Department of Anesthesiology and Pain Medicine
신용섭 ( Shin Yong-Sup ) - Chungnam National University College of Medicine Department of Anesthesiology and Pain Medicine
고영권 ( Ko Young-Kwon ) - Chungnam National University College of Medicine Department of Anesthesiology and Pain Medicine
정우석 ( Chung Woo-Suk ) - Chungnam National University College of Medicine Department of Anesthesiology and Pain Medicine
홍부휘 ( Hong Boo-Hwi ) - Chungnam National University College of Medicine Department of Anesthesiology and Pain Medicine

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.

키워드

Anesthesia; Brachial Plexus Block; Diaphragm; Incidence; Nerve Block; Paralysis; Phrenic Nerve; Propensity Score; Retrospective Studies; Ultrasonography
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