Unilateral Diaphragmatic Paralysis Research Articles

In a porcine model of implantable pacemakers for pediatric unilateral diaphragm paralysis, the phrenic nerve is the best target

BackgroundA frequent complication of Fontan operations is unilateral diaphragmatic paresis, which leads to hemodynamic deterioration of the Fontan circulation. A potential new therapeutic option is the unilateral diaphragmatic pacemaker. In this study, we investigated the most effective stimulation location for a potential fully implantable system in a porcine model.MethodsFive pigs (20.8 ± 0.95 kg) underwent implantation of a customized cuff electrode placed around the right phrenic nerve. A bipolar myocardial pacing electrode was sutured adjacent to the motor point and peripherally at the costophrenic angle (peripheral diaphragmatic muscle). The electrodes were stimulated 30 times per minute with a pulse duration of 200 µs and a stimulation time of 300 ms. Current intensity was the only variable changed during the experiment.ResultsEffective stimulation occurred at 0.26 ± 0.024 mA at the phrenic nerve and 7 ± 1.22 mA at the motor point, a significant difference in amperage (p = 0.005). Even with a maximum stimulation of 10 mA at the peripheral diaphragm muscle, however, no effective stimulation was observed.ConclusionThe phrenic nerve seems to be the best location for direct stimulation by a unilateral thoracic diaphragm pacemaker in terms of the required amperage level in a porcine model.

Orthopnea secondary to brachial plexitis with bilateral diaphragmatic paralysis

BackgroundDiaphragmatic paralysis can present with orthopnea. We report a unique presentation of bilateral diaphragmatic paralysis, an uncommon diagnosis secondary to an unusual cause, brachial plexitis. This report thoroughly describes the patient’s presentation, workup, management, and outcome. It also reviews the literature on diaphragmatic paralysis and Parsonage-Turner syndrome.Case presentationA 50-year-old male patient developed insidious orthopnea associated with left shoulder and neck pain over three months with no associated symptoms. On examination, marked dyspnea was observed when the patient was asked to lie down; breath sounds were present and symmetrical, and the neurological examination was normal. The chest radiograph showed an elevated right hemidiaphragm. Echocardiogram was normal. There was a 63% positional reduction in Forced Vital Capacity and maximal inspiratory and expiratory pressures on pulmonary function testing. The electromyogram was consistent with neuromuscular weakness involving both brachial plexus and diaphragmatic muscle (Parsonage and Turner syndrome).ConclusionsCompared to unilateral, bilateral diaphragmatic paralysis may be more challenging to diagnose. On PFT, reduced maximal respiratory pressures, especially the maximal inspiratory pressure, are suggestive. Parsonage-Turner syndrome is rare, usually with unilateral diaphragmatic paralysis, but bilateral cases have been reported.

Pulmonary blood flow in children with univentricular heart and unilateral diaphragmatic paralysis.

Spontaneous breathing has an important effect on pulmonary arterial blood flow in patients with Glenn/Fontan circulation. Unilateral diaphragmatic paralysis (DP) is a frequent complication after heart surgery in congenital heart disease. The aim of this study was to investigate the influence of unilateral DP on blood flow distribution in the pulmonary arteries with Glenn/Fontan circulation. Magnetic resonance phase-contrast imaging was used to evaluate stroke volume index (SVI) in the left and right pulmonary arteries in patients with Glenn/Fontan circulation with unilateral DP. Data for 18 patients with univentricular heart and unilateral DP were analysed, 8 in the Glenn stage and 10 in the Fontan stage. Ten patients had right-sided DP, and 8 had left-sided DP. A diaphragmatic plication was performed in 7 patients. The control group consisted of 36 patients with Glenn (n = 16)/Fontan (n = 20) circulation without DP. In both left- and right-sided DP, the SVI to the ipsilateral side was significantly lower than in controls [2.81 (1.45-4.50) ml/m2 left vs 11.97 (7.36-16.37) ml/m2 in controls, P < 0.0002; 8.2 (4.49-12.64) ml/m2 with right vs 12.64 (9.66-16.61) ml/m2 in controls; P = 0.0284]. The SVI to the contralateral side showed a slight but non-significant increase in the presence of unilateral DP. Unilateral DP in patients with Glenn/Fontan circulation has a negative impact on pulmonary arterial SVI on the side of the paralysis.

Quality-of-life impact of diaphragm plication in patients with diaphragmatic paralysis: A retrospective study.

While the overall incidence and prevalence of diaphragmatic paralysis are unknown due to a wide variety of underlying causes, symptomatic patients experience a marked decline in their quality of life. The goal of this study was to measure the impact of diaphragm plication surgery on the quality of life in patients who were diagnosed with diaphragmatic paralysis. A retrospective review of the medical records of 46 patients who underwent diaphragmatic plication surgery was performed. The review included patients who experienced unilateral and bilateral diaphragmatic paralysis. Patients who underwent repeat diaphragm plication surgery were also included in the study. Patients from the retrospective cohort were then contacted by telephone to answer the Dyspnea-12 (D-12) questionnaire. Patients were asked to recall the severity of their symptoms and quality of life preplication, 1-month postplication, and 6-month postplication. Severity of symptoms was ranked as either none, mild, moderate, or severe. Values were then assigned to each rank as follows: none = 0, mild = 1, moderate = 2, and severe = 3. Relative change and statistical significance were calculated with preplication measurements used as the baseline. Scores between preplication versus 1-month postplication and 6-month postplication were then compared by Student's paired t-test. All tests were two-sided and statistical significance was set at P < 0.05. Forty-six patients were included in the study, from which 21 answered the D-12 questionnaire. Average scores from each component of the D-12 questionnaire showed improvement in the severity of symptoms from preplication to 1-month postplication. The latter period was then followed by continued improvement in all areas when symptoms 6-month postplication were assessed. In patients with diaphragmatic paralysis, diaphragm plication was effective in reducing patients' symptoms while improving overall quality of life.

A rare case of phrenic nerve palsy after cervical spine surgery

Abstract Phrenic nerve palsy is a rare complication of cervical spine surgery. There are very few previously reported cases of unilateral diaphragmatic paralysis following posterior cervical spine surgery. We present a case of a 61-year-old man with cervical canal stenosis and myelopathy for which we performed C3–C6 laminectomy and lateral mass screw fixation. Postoperatively the patient developed right C5 palsy affecting his deltoid function which gradually improved. The patient developed respiratory distress postoperatively and was found to have an elevated hemidiaphragm secondary to phrenic nerve palsy. He was treated with respiratory support, with significant improvement in dyspnea. It is a very rare case of unilateral diaphragmatic paralysis causing dyspnea due to phrenic nerve palsy following cervical spine surgery. This rare complication should be kept in mind when assessing any patient with respiratory distress following cervical spine surgery.

Unilateral Diaphragmatic Paralysis Secondary to Neuralgic Amyotrophy—a Case Report

Unilateral Diaphragmatic Paralysis Secondary to Neuralgic Amyotrophy—a Case Report

Abstract 16019: Right Hemidiaphragm Paralysis Leading to Right Heart Failure

Background Diaphragmatic paralysis occurs due to direct or indirect damage to the phrenic nerve and can cause unilateral elevation. Diaphragmatic paralysis is usually asymptomatic; however, we present a case of syncope caused by right hemidiaphragm paralysis leading to extrinsic compression of the right heart causing hemodynamic compromise. Case A 78-year-old female with a history of advanced dementia, and hypertension presented following a syncopal episode and was found altered and hypotensive. A chest X ray showed an elevated right hemidiaphragm. A Transthoracic echocardiogram demonstrated hyperdynamic systolic function of the left ventricle with an ejection fraction of 70 to 75% and a left ventricular outflow tract (LVOT) gradient of 64 mmHg. It was suspected that extrinsic compression of the right atrium and ventricle lead to underfilling of the left ventricle causing LVOT obstruction resulting in hypotension and syncope. Discussion . Due to the patient’s underlying severe dementia her family wished for a conservative approach and additional cardiac investigation was deferred. She was treated conservatively with beta blockers to increase her diastolic filling time and intravenous fluids to promote LV filling in order to reduce her LVOT obstruction. Treatment of diaphragm paralysis depends on the severity of symptoms such as dyspnea on exertion, fatigue and syncope. An option that was discussed was diaphragmatic plication to decrease the intrathoracic pressure and the extrinsic compression on the right heart. More commonly, unilateral diaphragmatic paralysis is asymptomatic and is managed conservatively with observation. Conclusion: Cardiac complications of hemidiaphragm paralysis are rare but this case illustrates how extrinsic compression of the right heart can lead to dynamic LVOT obstruction and highlights the importance of integrating imaging findings when evaluating patients for syncope.

Temporary diaphragm pacing for patients at risk of prolonged mechanical ventilation after extensive aortic repair

ObjectiveProlonged mechanical ventilation (MV) after extensive aortic reconstructive surgery is common. Studies have demonstrated that diaphragm pacing (DP) improves lung function in patients with unilateral diaphragm paralysis. The goal of this study is to determine whether this technology can be applied to complex aortic repair to reduce prolonged MV and other respiratory sequelae. MethodsA retrospective review was performed of patients who underwent temporary DP after extensive aortic reconstructive surgery between 2019 and 2022. The primary end point was prolonged MV incidence. Other measured end points included diaphragm electromyography improvement, length of hospitalization, duration of intensive care unit stay, and reintubation rates. ResultsFourteen patients deemed at high risk of prolonged MV based on their smoking and respiratory history underwent DP after extensive aortic repair. The mean age was 70.2 years. The indications for aortic repair were a thoracoabdominal aortic aneurysm (n = 8, including 2 ruptured, 2 symptomatic, and 1 mycotic), a perivisceral aneurysm (n = 4), and a perivisceral coral reef aorta (n = 2). All patients had a significant smoking history (active or former) or other risk factors for ventilator-induced diaphragmatic dysfunction and prolonged MV. The mean total duration of MV postoperatively was 31.9 hours (range, 8.1-76.5 hours). The total average pacing duration was 4.4 days. Two patients required prolonged MV, with an average of 75.4 hours. Two patients required reintubation. No complications related to DP wire placement or removal occurred. ConclusionsDP is safe and feasible for patients at high risk of pulmonary insufficiency after extensive aortic reconstructive surgery.

Minimally-Invasive Diaphragmatic Plication in Patients with Unilateral Diaphragmatic Paralysis.

Background: Diaphragm eventration (DE) represents a frequent problem with consecutive major impacts on respiratory function and the quality of life of the patients. The role of diaphragmatic plication (DP) is still underestimated. The aim of the present study is to evaluate the efficacy of minimally-invasive surgical diaphragmatic plication for the management of unilateral diaphragmatic eventration, to the best of our knowledge, this is the largest series reported in the literature using a non-resectional technique. Methods: All patients with unilateral diaphragmatic paralysis admitted for diaphragmatic plication (DP) between January 2008 and December 2022 formed the cohort of this retrospective analysis. DP procedure was done to plicate the diaphragm without resection or replacement with synthetic materials. Patients were divided into two groups: Group I included patients who underwent DP through an open thoracotomy, and Group II included patients who underwent DP through video-assisted thoracoscopic surgery (VATS). Data from all patients were collected prospectively and subsequently analyzed retrospectively. Patients' characteristics, lung function tests, radiological findings, type of surgical procedures, complications, and postoperative follow-up were compared. The primary outcome measure was the postoperative result (deeper position of the paralyzed diaphragm) and improvement of dyspnea. The secondary outcome was lung function values over a long-term follow-up. Results: The study included a total of 134 patients who underwent diaphragmatic plication during the study period. 94 (71.7%) were males, mean age of 64 (SD ± 14.0). Group I (thoracotomy group) consisted of 46 patients (35 male). Group II (VATS-group) consisted of 88 patients (69 male). The majority of patients demonstrated impaired lung functions (n = 126). The mean length of diaphragmatic displacement was 8 cm (SD ± 113.8 cm). The mean duration of the entire procedure, including placement of the epidural catheter (EDC), was longer in group I than in group II (p = 0.016). This was also observed for the mean length of the surgical procedure itself (p = 0.031). Most patients in group I had EDC (n = 38) (p = 0.001). Patients in group I required more medication for pain control (p = 0.022). A lower position of the diaphragm was achieved in all patients (p < 0.001). The length of hospital stay was 7 (SD ± 4.5) days in group I vs. 4.5 (SD ± 3.2) days in group II (p = 0.036). Minor complications occurred in 3% (n = 4) in group I vs. 2% (n = 3) in group II. No mortality was observed in any of the groups. Postoperative follow-up of patients at 6, 12, and 24 months showed a significant increase in forced vital capacity (FVC) up to 25% (SD ± 10%-35%) (p = 0.019), in forced expiratory volume in 1 s (FEV1) up to 20% (SD ± 12%-38%) in both groups (p = 0.026), also in the diffusion capacity of carbon monoxide (DLCO) up to 15% (SD ± 10%-20%) was noticed in both groups. Chronic pain symptoms were noted in 13% (n = 6) in group I vs. 2% (n = 2) in group II (p = 0.014). Except for one patient in group II, no recurrence of DE was observed. Conclusions: Diaphragm plication is an effective procedure to reduce debilitating dyspnea and improve lung function in patients suffering from diaphragm eventration. Minimally invasive diaphragmatic plication using VATS procedures is a safe and feasible procedure for the management of unilateral diaphragmatic paralysis. VATS-DP is superior to open procedure in terms of pain management and length of hospital stay, hence, accelerated recovery is more likely. Careful patient selection is crucial to achieving optimal outcomes. Prospective studies are needed to validate these results.

Unilateral Diaphragm Paralysis Following COVID-19 Infection: A Case Report

We report a patient case of unilateral diaphragm paralysis following COVID-19 infection. A 55-year-old healthy man was infected with SARS-CoV-2 before the availability of a vaccine. He was intubated and pronated for respiratory failure. He experienced new debilitating dyspnea and orthopnea for 6 months after recovery. Dynamic chest radiography demonstrated a new hemidiaphragm paralysis. After surgical plication of the diaphragm, the patient's symptoms resolved. This patient case demonstrates the importance of thorough evaluation for diaphragm paralysis in patients who have suffered COVID-19 infection when there is persistent dyspnea or orthopnea, as well as the neuroinvasive potential of the virus that has yet to be fully explained.

Unilateral Diaphragmatic Paralysis After Stereotactic Ablative Radiation Therapy to a Lung Tumor Abutting the Course of the Phrenic Nerve

We present the case of a woman with metastatic adenoid cystic carcinoma who received stereotactic ablative radiation therapy with a total dose of 50 Gy in 4 fractions to 2 lung metastases and developed symptomatic left phrenic nerve injury 2 years after radiation. The maximum dose to the approximate location of the phrenic nerve was 57.7 Gy, which corresponds to a biologically effective dose for late effects (using α/β ratio = 3) of 335.14 Gy. Here, we discuss the case, planning considerations by radiation oncologists and medical physicists, and the multidisciplinary medical management of this patient.

Phrenic nerve neurorrhaphy with a sural nerve graft in unilateral diaphragmatic paralysis

Unilateral diaphragmatic paralysis can present following damage or impairment to a phrenic nerve. In cases where current treatment methods are not feasible, the use of a double phrenic nerve neurorrhaphy with an autologous sural nerve graft should be investigated. In preserved rats, the feasibility of this technique was explored. The sural nerve was excised from the left thigh. Entering into the thoracic cavity bilaterally through the fifth intercostal spaces, the right and left phrenic nerves were identified. The right phrenic nerve was cut to create a distal nerve stump. The sural nerve was grafted onto the distal stump of the right phrenic nerve and the side of the left phrenic nerve. Using six preserved rat cadavers, the end-to-side graft was successfully explored and performed. It was determined that approximately 2.5–3 cm of the sural nerve will be required to be harvested for the graft. The sural nerve was an appropriate size for grafting onto the phrenic nerves. Four 10–0 Nylon sutures were sufficient for each neurorrhaphy. A double phrenic nerve neurorrhaphy with an autologous sural nerve graft is potentially feasible in rat models.

Vocal Impact in Patients With Unilateral Diaphragmatic Paralysis

This study aimed to investigate the possible vocal impact confirmed by diagnostic tests, the degree of perception of possible vocal impairment by patients with Unilateral Diaphragmatic paralysis (UDP) and its correlation with ventilatory weakness. The researchers conducted an analytical, observational and case-control study with 70 individuals, including 35 UDP patients and 35 healthy patients in a control group, who underwent the following assessments: 1) Self-assessment of voice handicap (VHI-10); 2) Self-Assessment of Quality of Life (SF-36); 3) Self-Assessment of Dyspnea (MRC); 4) Objective vocal measures (Maximum Phonation Time (MPT) in /a/, /s/, /z/ and glottal-to-noise excitation ratio); 5) Functional respiratory pressures (Spirometry and maximum ventilatory pressures); 6) General degree of dysphonia - G on the GRBAS Scale. The sex, age and body mass index (BMI) of the individuals were the variables used to match the sample of this study. When compared with controls, patients with UDP had a restrictive functional pattern and inspiratory weakness, with symptoms of dyspnea and worsening quality of life. When associated with a possible vocal impact, these patients had voice handicap and decreased MPT values for all phonemes, especially /a/. There was also a correlation between vocal performance and inspiratory weakness. However, it should be noted that, despite having vocal impairment, many patients did not report the perception of this fact, somehow neglecting such impairment. In addition to the expected weakness of the ventilatory muscles, patients with UDP had clinically verified vocal impact, and those who had greater inspiratory weakness also had greater voice impairment. Finally, it is relevant that not all patients perceived such vocal impact, which showed a very reduced perception of this impairment in patients with UDP.

Sleep Disordered Breathing Postcoronary Artery Bypass Graft Surgery: A Case Report

Unilateral diaphragmatic paralysis (UDP) is usually found incidentally in those who underwent chest radiography for some other reason. Often patients are asymptomatic at rest but may have breathlessness upon exertion and have a decrease in exercise capacity. Dyspnea at rest may occur if the patient has an underlying lung disease. Few develop orthopnea, which is less intense than patients with bilateral diaphragmatic paralysis (DP). Others present with positional snoring and progressive orthopnea misinterpreted it as sleep-disordered breathing. Here we present a 54-year-old male who presented late with sleep-disordered breathing and was diagnosed to have diaphragmatic palsy postcoronary artery bypass graft.

Minimally Invasive Diaphragm Plication for Acquired Unilateral Diaphragm Paralysis: A Systematic Review.

Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.

Unilateral Diaphragm Paralysis secondary to Subarachnoid Hemorrhage and Ischemic Stroke with Phrenic Nerve Dysfunction: A casereport

Unilateral Diaphragm Paralysis secondary to Subarachnoid Hemorrhage and Ischemic Stroke with Phrenic Nerve Dysfunction: A casereport

The Diagnosis of Unilateral Diaphragmatic Paralysis Using M-mode: A Case Report from Palestine

Background: Diaphragmatic paralysis is one the causes of dyspnoea and difficulty in breathing. There are many causes of diaphragmatic paralysis, especially trauma and iatrogenic injury of phrenic nerve. Usually, diaphragmatic paralysis diagnosis depends on fluoroscopic examination of diaphragmatic displacement during sharp sniffs. However, due to disadvantages of fluoroscopic examination, the trend for less radiation examination by using ultrasound is increasing especially using M-mode for detection of diaphragmatic motion during respiration. Case: A new-born baby boy with uneventful pregnancy and normal delivery with good general condition, developed severe respiratory distress at 3rd day of life and was diagnosed to have bilateral pneumothorax. Bilateral chest tubes were inserted with improvement of his condition. The baby then started to develop desaturation with serial chest x-rays done and showed elevated left hemi-diaphragm. Suspicion toward left hemi-diaphragm paralysis increased and due to his general condition, fluoroscopic examination was difficult. So that, Ultrasound with M-mode was used with diagnosis of the patient with left hemi-diaphragmatic paralysis. Conclusion: Ultrasound and the using of M-mode in detection of diaphragmatic motion is one of the most important and applicable diagnostic procedure for diagnosis of diaphragmatic weakness and paralysis.

Results of the Diaphragmatic Plication Database: 10 Years' Experience.

Unilateral diaphragmatic paralysis or paresis (UDP) in adults is an often overlooked disease which relevantly impairs the patient's lung function and quality of life. Particularly in idiopathic UDP, there is no evidence for conservative therapy and only little evidence for surgical therapy. The method involves retrospective single-center analysis of patients with UDP persistent for at least 1 year who were operated by diaphragmatic resection, plication, and augmentation with a polypropylene mesh. The patients were tested for lung and diaphragmatic function, six-minute walk test (6MWT), and blood gas analysis before, 3 and 12 months after surgery. In total, 85 patients received surgery for UDP. The most frequent reasons for UDP were idiopathic (67%), iatrogenic (mainly cardiac and cervical spine surgery; 24%), and trauma (9%). The mean operation time was 84 ± 24 minutes, the length of hospital stay 8.4 ± 3.9 days, chest tubes were removed after 11.7 ± 4.1 days. Overall morbidity was 42%, mortality 0%. Forced expiratory volume in one second (FEV1) in supine position improved by 12.4% absolute, vital capacity by 11.8% absolute, and sniff nasal inspiratory pressure by 1.4 kPa 12 months after surgery (p <0.001 each). Total lung capacity increased by 6.8% absolute at 12 months (p = 0.001) The 6MWT distance improved by 45.9 m at 3 months and 50.9 m at 12 months (p = 0.001, each). Surgical therapy for UDP is highly effective in the long term. The superiority over conservative treatments needs to be evaluated prospectively with standardized physiotherapeutic protocols. FEV1 in supine position and 6MWT are easy to perform tests and represent statistically and patient-relevant outcomes.

Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences?

Individuals with Duchenne muscular dystrophy (DMD) frequently develop sleep-disordered breathing. Noninvasive ventilation is often prescribed for sleep-disordered breathing treatment based on the American Academy of Sleep Medicine (AASM) criteria. In 2018, DMD disease-specific criteria for sleep-disordered breathing were established. Our study aimed to examine the clinical interpretation differences using these different criteria. We performed a multicenter, retrospective chart review of children with DMD followed at The Hospital for Sick Children, Toronto, Canada, and Rady Children's Hospital, San Diego, California, who underwent polysomnography from August 1, 2012, to February 29, 2020. Baseline characteristics and polysomnography data were summarized using descriptive statistics. Agreement for the diagnosis of sleep-disordered breathing evaluated by kappa statistics and sensitivity/specificity analysis was assessed. One hundred five male children with DMD (mean ± SD age: 12.1 ± 3.8 years; body mass index z score: 0.2 ± 2.3) were included. The proportions of children with DMD that met at least 1 AASM criterion and at least 1 DMD criterion were 45.7% and 67.6%, respectively. We found that 32.4% of children met neither AASM nor DMD criteria. Overall agreement between AASM and DMD criteria was moderate (k = 0.57). There was almost perfect agreement in sleep apnea diagnosis (k = 0.90); however, there was only slight agreement in hypoventilation diagnosis (k = 0.12) between AASM and DMD criteria. There were more children with DMD diagnosed with nocturnal hypoventilation and prescribed noninvasive ventilation using DMD criteria compared with AASM criteria. Future studies should address whether the prescription of noninvasive ventilation for children with DMD based on both criteria is associated with different clinical outcomes. Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med. 2022;18(2):609-615.

A Comparison of Costoclavicular Block and Interscalene Block for Pain Relief after Arthroscopic Shoulder Surgery

Abstract Introduction Interscalene block (ISB) is commonly used for efficient pain relief after arthroscopic shoulder surgery. But, it is linked with a greater occurrence of unilateral diaphragmatic paralysis (UDP). This may add to patient dissatisfaction and also may not be tolerated well by patients having respiratory diseases. We have compared the efficacy of costoclavicular block (CCB) with ISB for postoperative analgesia in patients undergoing arthroscopic shoulder surgery. Materials and Methods Fifty patients were divided into two groups of 25 each (ISB or CCB group). In total, 20 mL of 0.5% levobupivacaine along with 4 mg of dexamethasone as adjuvant was used during both ultrasound-guided ISB and CCB. Numerical rating scale (NRS) scores for pain were assessed at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours in postoperative period. The mean onset time of block, time of first painkiller demand, total painkiller demand for 24 hours postoperatively, patient wellbeing, incidence of UDP, and any other complications were recorded. Results NRS pain scores in both groups at 0, 0.5, 1, 2, 3, 6, 12, and 24 hours were comparable. (p &gt; 0.05) Mean onset time of block was earlier in ISB group contrary to CCB group (p &lt; 0.05). There was higher occurrence of UDP in ISB group contrary to CCB group (p &lt; 0.05). There was no notable variation regarding the time of first painkiller demand and total painkiller demand in the first 24 hours. Patients were more satisfied in CCB group contrary to ISB group. Conclusion As CCB provided equivalent analgesia in postoperative period like ISB without any risk of UDP, it can be a better substitute to ISB for pain relief in arthroscopic shoulder surgery.