Abstract
The importance of phrenic nerve preservation during pneumonectomy remains controversial. We previously demonstrated that preservation of the phrenic nerve in the immediate postoperative period preserved lung function by 3-5% but little is known about its long-term effects. We, therefore, decided to investigate the effect of temporary ipsilateral cervical phrenic nerve block on dynamic lung volumes in mid- to long-term pneumonectomy patients. We investigated 14 patients after a median of 9 years post pneumonectomy (range: 1-15 years). Lung function testing (spirometry) and fluoroscopic and/or sonographic assessment of diaphragmatic motion on the pneumonectomy side were performed before and after ultrasonographic-guided ipsilateral cervical phrenic nerve block by infiltration with lidocaine. Ipsilateral phrenic nerve block was successfully achieved in 12 patients (86%). In the remaining 2 patients, diaphragmatic motion was already paradoxical before the nerve block. We found no significant difference on dynamic lung function values (FEV1 'before' 1.39 ± 0.44 vs FEV1 'after' 1.38 ± 0.40; P = 0.81). Induction of a temporary diaphragmatic palsy did not significantly influence dynamic lung volumes in mid- to long-term pneumonectomy patients, suggesting that preservation of the phrenic nerve is of greater importance in the immediate postoperative period after pneumonectomy.
Highlights
Even nowadays, more than 80 years after the first successfully performed pneumonectomy by Graham and Singer in 1933 [1], the importance of phrenic nerve preservation during pneumonectomy is unclear
We previously demonstrated that preservation of the phrenic nerve in the immediate postoperative period preserved lung function by 3–5% but little is known about its long-term effects
Induction of a temporary diaphragmatic palsy did not significantly influence dynamic lung volumes in mid- to long-term pneumonectomy patients, suggesting that preservation of the phrenic nerve is of greater importance in the immediate postoperative period after pneumonectomy
Summary
More than 80 years after the first successfully performed pneumonectomy by Graham and Singer in 1933 [1], the importance of phrenic nerve preservation during pneumonectomy is unclear. Ugalde et al [3] investigated the effect of ipsilateral diaphragmatic motion on lung function in long-term pneumonectomy patients and described significantly better dynamic lung values in patients with a functional diaphragm years after the procedure They did, compare two different groups of patients with a working and a non-working diaphragm, respectively, rather than investigate the effect of diaphragmatic palsy in the same cohort. This was recently done by Kocher et al [4] but only in the early postoperative course following pneumonectomy where a modest but significant deterioration of dynamic lung volumes was observed when the ipsilateral diaphragm was paralysed by lidocaine. In order to elucidate whether the impact of phrenic nerve palsy increases further with time after the operation, as the results of the Canadian study suggest [3], we decided to investigate the effect of ipsilateral phrenic nerve palsy induction on diaphragmatic motion and lung function in mid- to long-term pneumonectomy patients
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