Permanent diaphragm paralysis after ISB

[Intubate]

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Did you guys read this article? Interesting stuff about incidence and pathophysiology of phrenic nerve injury in ISB.
http://journals.lww.com/anesthesiol...ical_Treatment_of_Permanent_Diaphragm.38.aspx

 

[epidural man]

Did you guys read this article? Interesting stuff about incidence and pathophysiology of phrenic nerve injury in ISB.
http://journals.lww.com/anesthesiol...ical_Treatment_of_Permanent_Diaphragm.38.aspx

Very interesting.

This raises some questions.

1. How does a needle stick cause scaring about the phrenic nerve?

2. Who is doing interscalene blocks with a needle passing through the anterior scalene?

3. Ultrasound guidance means nothing really. I would like more info. Where the blocks done out of plane? does ultrasound guidance mean they visualized needle tip the whole time? What approach was used?

4. b-bevel?

 

[BLADEMDA]

Did you guys read this article? Interesting stuff about incidence and pathophysiology of phrenic nerve injury in ISB.
http://journals.lww.com/anesthesiol...ical_Treatment_of_Permanent_Diaphragm.38.aspx

I read the study and editorial. The study is vague in terms of patient data, Approach/Technique for ISB, total number of patients who didn't get a complication, etc.


For all we know the overall complication rate is 1 in 15,000 using the anterior approach with just a nerve stimulator vs 1 in 100,000 using the lateral/posterior approach with ultrasound.

I remain unimpressed with the study and its lack of clarity. Is it applicable in 2013?
Too many unanswered questions remain and no double blind study has ever shown significant morbidity due to phrenic nerve injury.

Hence, at this time there is no need to change your posterior/lateral approach for an ISB under U/S guidance. However, consider adding a nerve stimulator to decrease injury to the adjacent nerves on your way to the plexus.

 

[Idiopathic]

Very interesting.

This raises some questions.

1. How does a needle stick cause scaring about the phrenic nerve?

2. Who is doing interscalene blocks with a needle passing through the anterior scalene?

3. Ultrasound guidance means nothing really. I would like more info. Where the blocks done out of plane? does ultrasound guidance mean they visualized needle tip the whole time? What approach was used?

4. b-bevel?

i dont think they were asserting that there was direct trauma to the phrenic (i.e. passing through the anterior scalene); rather that multiple needle passes and large volume injectsion compress surrounding structures, causing edema and scar tissue (theoretically)