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ULTRASOUND EVALUATION OF PHRENIC NERVE PARALYSIS FOLLOWING BRACHIAL PLEXUS BLOCK USING M-MODE ULTRASOUND
ESRA Academy. Lewinsohn B. Sep 8, 2016; 138265
Topic: Upper Limb Blocks - Brachial Plexus Block
Disclosure(s): Sonosite - Loan of ultrasound machine for audit purpose - no monetary support
Bradley Lewinsohn
Bradley Lewinsohn

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Abstract
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Background and Aims:

The use of real time ultrasound guided brachial plexus blocks is regarded as a gold standard. Previous papers utilising a nerve stimulator technique have suggested that the supraclavicular approach to the brachial plexus would result 50% of patients experiencing complete phrenic nerve paralysis and 17% partial paralysis.1 We propose to observe the rates of paralysis using ultrasound M mode to assess diaphragmatic function.2

Methods:

Patients were scheduled for a block as per usual practice and consented for second scan to measure diaphragm movement. The block was carried out by the anaesthetist conducting the list and then measurements taken by a chest ultrasound trained anaesthetist using M-mode. A second measurement was then made after adequate block judged by loss of sensory and motor function. A change of more than 30% was considered as partial paralysis and more than 70% as complete paralysis. We also included patients receiving axillary and inters scalene blocks as control subjects to validate our results.

Results:

We collected 25 patients into this audit. As expected the higher up in the brachial plexus the larger the incidence of phrenic nerve paralysis. No patients experienced any breathlessness or drop in saturations on room air.






Conclusions:

Our results show rates of 12% experiencing complete paralysis and 50% partial paralysis which was much lower than the rates using nerve stimulator technique despite using similar volumes of around 0.5mls/kg.

References:
1. Mak, Irwin, Ooi, Chow. Incidence of diaphragmatic paralysis following supraclavicular block and its effects on pulmonary function. Anaesthesia. 2001;(56):350-369.
2.Gerscovich, Cronan. Diaphragmatic Motion. J Ultrasound Med. 2001;(20):597-604.

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