Course diaphragmatique après bloc inter-sterno-cléido-mastoïdien, en fonction du site d'injection

Abstract

Objective: To evaluate the incidence of the hemidiaphragmatic paresis after inter Sterno-Cleido-Mastoid (inter-SCM) block. Study design: Prospective, comparative, single blind study. Patients: 16 patients ASA I-II. Methods: The diaphragmatic paresis was mesured by a radiologist unaware of the technique used and operated side. It was determined by the diaphragmatic excursion (DE) on double-exposure chest radiography, obtained preoperatively and postoperatively (DE-pre, DE-post) for the ipsilateral and controlateral side of the inter-SCM block. All the patients were given 20 mL 0.5% bupivacaine plus 20 mL 2% lidocaine both with epinephrine. These anesthetics were injected via the stimuling needle or via the catheter after opacified radiological control of the catheter position. The patients were divided into 2 groups. Group 1: injection via the needle after eliciting flexion of fingers, or via a catheter into infraclavicular position ; group 2: injection via the needle after eliciting contraction of deltoid, or elbow flexion, or via a supraclavicular catheter. Results: All the patients had satisfactory block. The ipsilateral DE was decreased after injection of anesthetics in group 2 ( P < 0.001) while it remained unchanged in groupe 1. Conclusion: The diaphragmatic paresis is avoidable with the inter-SCM block if and only if the anesthetic solution is injected via the needle after stimulating flexion of fingers or via a catheter into infraclavicular position.