Abstract ID: A30

Abstract Title: The Vertical Infraclavicular Block influences hemidiaphragmatic movement and ventilatory function

Poster Type: Either

ABSTRACT BODY

The Vertical Infraclavicular Block (VIB ) influences hemidiaphragmatic movement and ventilatory function.

Mathieu J. Gielen MD, PhD * and Harald C. Rettig #.
* Radboud University Nijmegen. # Ikazia Hospital Rotterdam. The Netherlands.

Introduction.
Two infraclavicular blocks for brachial plexus anaesthesia, the coracoid block and the modified Raj technique have no influence on hemidiaphramatic movement (HDM) or pulmonary function (1,2). These effects have not been investigated in the vertical infraclavicular block (VIB) as described by Kilka et al. (3).

Material and Methods.
35 healthy patients scheduled for surgery under brachial plexus block were investigated. The VIB was performed successfully in 34 patients with ropivacaine 0.75%, 0.5 ml/kg. HDM, vital capacity (VC) and forced expiratory volume (FEV1) were assessed before and 5, 10, 30 and 60 minutes after placement of the block.

Results.
In 9 of 34 patients (26%) a change in HDM (reduced or paradoxical) was observed. All but one patient had a reduced VC and FEV1 of around 30%. None of the patients experienced any respiratory symptoms. Horner’s syndrome was seen in four patients and all these had a change in HDM.

Discussion.
The VIB can result in a change of HDM with a decrease of ventilatory function. It is the most proximal approach of the three infraclavicular techniques that block the brachial plexus. The LA injected at this level seems to reach the phrenic nerve in 26% of patients. Although a decrease in ventilatory function was measured, no respiratory symptoms were observed in this study since only healthy patients were included. Our results suggest that this block is not advisable in patients who cannot tolerate a reduction of 30% in ventilatory function.

References

1. Rodriguez J, Barcena M, Rodriguez V, Aneiros F, Alvarez J. Infraclavicular brachial plexus block effects on respiratory function and extent of the block. Reg Anesth Pain Med 1998; 23: 564-568.
2. Dullenkopf A, Blumenthal S, Theodorou P, Roos J, Perschak H, Borgeat A. Diaphragmatic excursion and respiratory function after modified Raj technique of the infraclavicular plexus block. Reg Anesth Pain Med 2004; 29: 110-114.
3. Kilka HG, Geiger P, Mehrkens HH. Die infraclaviculäre Blockade des Plexus Brachialis. Infraclavicular vertical brachial plexus block. A new method for anaesthesia of the upper extremity. Anaesthesist 1995; 44: 339-344.

ATTACHED FILES

Reg Anesth Pain Med 2004; 29(2):A30