Usefulness of diaphragmatic ultrasound in the early diagnosis of phrenic nerve palsy after shoulder surgery in the prevention of post-operative respiratory complications

Abstract Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5–C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

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Effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for arthroscopic shoulder surgery: a prospective observational study

10.21203/rs.2.14086/v1 ◽

2019 ◽

Author(s):

Byung-Gun Kim ◽

Woojoo Lee ◽

Hyunzu Kim ◽

Chunwoo Yang ◽

Yoon Sang Jeon ◽

...

Keyword(s):

Brachial Plexus ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Brachial Plexus Block ◽

Suprascapular Nerve ◽

Shoulder Surgery ◽

Phrenic Nerve Palsy ◽

Interscalene Brachial Plexus Block ◽

Arthroscopic Shoulder Surgery ◽

Plexus Block

Abstract Background Although interscalene brachial plexus block provides effective anesthesia and analgesia for shoulder surgery, one major drawback of interscalene brachial plexus block is ipsilateral phrenic nerve palsy. Several diaphragm-sparing nerve blocks have been suggested. We prospectively evaluated the effectiveness of combined suprascapular nerve and costoclavicular brachial plexus block for postoperative analgesia following arthroscopic shoulder surgery.Methods Nineteen patients scheduled for arthroscopic shoulder surgery received combined ultrasound-guided suprascapular nerve and costoclavicular brachial plexus block. Pain scores, use of supplemental analgesia, incidence of phrenic nerve palsy, block-related outcomes, patient satisfaction, and adverse effects were assessed.Results The block was successful in 17 patients (89.5%). Postoperative pain control was effective during the first 24 h after surgery. Phrenic nerve palsy did not occur (0%, 95% confidential interval 0 – 17%). There were no severe adverse events. Patients reported a high degree of satisfaction.Conclusion Combined suprascapular nerve and costoclavicular brachial plexus block provided effective postoperative analgesia for arthroscopic shoulder surgery without causing phrenic nerve palsy.

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Carotid-Axillary Bypass as an Alternative to Carotid-Subclavian Bypass Following Coverage of Left Subclavian Artery During TEVAR

Vascular and Endovascular Surgery ◽

10.1177/1538574420983655 ◽

2020 ◽

pp. 153857442098365

Author(s):

Michael H. Parker ◽

Dayle K. Colpitts ◽

Genevieve F. Gilson ◽

Liam Ryan ◽

Dipankar Mukherjee

Keyword(s):

Subclavian Artery ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Left Subclavian Artery ◽

Vascular Complications ◽

Complication Rates ◽

Nerve Injuries ◽

Phrenic Nerve Palsy ◽

Safe Alternative ◽

Landing Zone

Introduction: Thoracic Endovascular Aortic Repair (TEVAR) has become the procedure of choice for pathology involving the descending thoracic aorta since its approval by the FDA in 2005. Left subclavian artery (LSA) coverage is commonly required to facilitate an adequate proximal landing zone for the endograft. The traditional revascularization procedure of choice is carotid-subclavian bypass, however recent studies report complication rates as high as 29%—specifically phrenic nerve palsy in 25% of patients undergoing this procedure. Our aim is to present our experience using carotid-axillary bypass as a safe alternative to carotid-subclavian bypass. Methods: All patients undergoing carotid-axillary bypass for TEVAR with LSA coverage between June 2016 and September 2019 at a tertiary medical center were retrospectively identified. Short-term and long-term complications were identified and analyzed including: phrenic nerve, recurrent laryngeal nerve, and axillary nerve injuries, as well as local vascular complications requiring re-intervention. All perioperative chest radiographs were reviewed for new hemidiaphragm elevation to assess for phrenic nerve injuries. Results: 35 patients underwent carotid-axillary bypass in conjunction with TEVAR during this time period. The majority of bypasses were performed concurrently with TEVAR (80.0%, 28/35) utilizing GORE PROPATEN 8 mm externally supported vascular graft (91.4%, 32/35). The complication rate specific to carotid-axillary bypass was 14.3% (5/35). We observed a significantly lower (0%, 0/35, P < 0.01) rate of phrenic nerve palsy for carotid-axillary bypass compared to the previously reported 25% (27/107) for carotid-subclavian bypass. For patients with available follow-up imaging (85.7%, 30/35), there was a 100% patency rate at time intervals ranging from 0-1066 days (IQR = 3-37.8). Conclusion: Carotid-axillary bypass can be performed as a safe alternative to carotid-subclavian bypass for LSA coverage during TEVAR involving a more superficial anatomic course of dissection. Phrenic nerve palsy, a well-described complication of the traditional carotid-subclavian bypass, was not observed in this retrospective series.

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Phrenic nerve palsy: a rare complication of indwelling subclavian vein catheter

Pediatric Nephrology ◽

10.1007/s004670050041 ◽

2000 ◽

Vol 14 (3) ◽

pp. 203-204 ◽

Cited By ~ 12

Author(s):

S. Aggarwal ◽

P. Hari ◽

A. Bagga ◽

S.N. Mehta

Keyword(s):

Phrenic Nerve ◽

Subclavian Vein ◽

Nerve Palsy ◽

Rare Complication ◽

Phrenic Nerve Palsy ◽

Vein Catheter

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Unilateral Phrenic Nerve Palsy: A Rare Manifestation of Vincristine Neurotoxicity: Authors’ Reply

The Indian Journal of Pediatrics ◽

10.1007/s12098-014-1393-8 ◽

2014 ◽

Vol 81 (12) ◽

pp. 1430-1430

Author(s):

Dhulika Dhingra ◽

Gulshan Rai Sethi ◽

Mukta Mantan

Keyword(s):

Phrenic Nerve ◽

Nerve Palsy ◽

Phrenic Nerve Palsy ◽

Rare Manifestation

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Isolated Phrenic Nerve Palsy in the Newborn

PEDIATRICS ◽

10.1542/peds.49.3.449 ◽

1972 ◽

Vol 49 (3) ◽

pp. 449-451

Author(s):

Barry T. Smith

Keyword(s):

Differential Diagnosis ◽

Respiratory Distress ◽

Newborn Infant ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Forceps Delivery ◽

Phrenic Nerve Palsy ◽

Newborn Period ◽

History Of

A case of isolated phrenic nerve palsy in a newborn infant following a difficult forceps delivery is described. Treatment was supportive and complete clinical and radiological recovery occurred between the tenth and eighteenth days of life. Phrenic nerve palsy should be considered in the differential diagnosis of respiratory distress in the newborn period, especially if there is a history of traumatic delivery or if a brachial palsy is present.

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Right Phrenic Nerve Palsy Post Coronary Artery Bypass Grafting (CABG) without Harvesting Right Internal Mammary Artery (RIMA): A Rare and Unexpected Complication

Journal of Clinical & Experimental Cardiology ◽

10.4172/2155-9880.1000406 ◽

2015 ◽

Vol 6 (10) ◽

Author(s):

Mohamed A Alassal ◽

Nouf F Baker ◽

Ayman M Shaalan ◽

Sumanth N Raghunayakula

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Coronary Artery Bypass ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Internal Mammary Artery ◽

Artery Bypass ◽

Bypass Grafting ◽

Phrenic Nerve Palsy ◽

Internal Mammary

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Safety and efficacy of cryoballoon-ablation for atrial fibrillation performed at local hospitals: results of the german register on cryoballoon-ablation in local hospitals (REGIONAL)

EP Europace ◽

10.1093/europace/euab116.230 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

J Michaelsen ◽

U Parade ◽

H Bauerle ◽

K-D Winter ◽

U Rauschenbach ◽

...

Keyword(s):

Atrial Fibrillation ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Pulmonary Veins ◽

Hospital Death ◽

Cryoballoon Ablation ◽

Complication Rates ◽

Community Hospitals ◽

Phrenic Nerve Palsy ◽

Safety And Efficacy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf REGIONAL Background Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at community hospitals with low to moderate case numbers is unknown. Aim To determine safety and efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. Methods 1004 PVI performed consecutively between 01/2019 and 09/2020 at 20 community hospitals (each <100 PVI using CBA/year) for symptomatic paroxysmal AF (n = 563) or persistentAF (n= 441) were included in this registry. CBA was performed considering local standards. Procedural data, efficacy and complications were determined. Results Mean number of PVI using CBA/year was 59 ± 26. Mean procedure time was 90.1 ± 31.6 min and mean fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients, early termination of CBA due to phrenic nerve palsy was the most frequent reason for incomplete isolation. There was no in-hospital death. 2 patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in 6 patients (0.6%), 2 of them (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), in 2 of these patients (0.2%) vascular surgery was required. In 48 patients (4.8 %) phrenic nerve palsy was noticed which persisted up to hospital discharge in 6 patients (0.6%). Conclusions PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high efficacy and low complication rates despite low to moderate annual procedure numbers.

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