Abstract
The phrenic nerve arises from fibers of the primary ventral ramus of the fourth cervical nerve, with contributions from the third and fifth cervical nerves. The phrenic nerve passes inferiorly between the omohyoid and sternocleidomastoid muscles and exits the root of the neck between the subclavian artery and vein to enter the mediastinum. The right phrenic nerve follows the course of the vena cava to provide motor innervation to the right hemidiaphragm. The left phrenic nerve descends to provide motor innervation to the left hemidiaphragm in a course parallel to that of the vagus nerve. Phrenic nerve block is useful in the diagnosis and treatment of intractable hiccups. It is also occasionally useful as both a diagnostic and therapeutic maneuver to determine whether pain from subdiaphragmatic processes, including abscess and malignancy, is being mediated via the phrenic nerve. Phrenic nerve block with local anesthetic is also used in a prognostic manner before destruction of the phrenic nerve for palliation of intractable hiccups.
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