Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics.

Abstract

We studied the effects of unilateral hemidiaphragmatic paresis caused by interscalene brachial plexus block on routine pulmonary function in eight patients. In an additional four patients, we studied changes in chest wall motion during interscalene block anesthesia by chest wall magnetometry. Ipsilateral hemidiaphragmatic paresis, as diagnosed by ultrasonography, developed in all patients within 5 min of interscalene injection of 45 mL of 1.5% mepivacaine with added epinephrine and bicarbonate. Large decreases in all pulmonary function variables were measured in every patient. Forced vital capacity and forced expiratory volume at 1 s decreased 27% +/- 4.3% and 26.4% +/- 6.8%, respectively (P = 0.0001). Peak expiratory and maximum midexpiratory flow rates were also significantly reduced. Interscalene block caused changes in pulmonary function and chest wall mechanical motion that were similar to those published in previous studies on patients with hemidiaphragmatic paresis of pathological or surgical etiology. Interscalene block probably should not be performed in patients who are dependent on intact diaphragmatic function and in those patients unable to tolerate a 25% reduction in pulmonary function.