Frecuencia y factores relacionados con parálisis diafragmática posterior a la realización de bloqueos interescalénico, del tronco superior y supraclavicular, guiados por ultrasonido, en un hospital de tercer nivel de Bogotá

Abstract

Introduction: blockages on the clavicle are associated with phrenic nerve block in different degrees, which leads to ipsilateral diaphragmatic paralysis. These comprise interscalcenic blockage, supraclavicular block, and upper trunk block has recently been described, where local anesthesia is administered directly on the trunk formed by the nerve roots of C5 and C6; This blockage has advantages because it requires less volume to achieve the anesthetic or analgesic effect. The objective was to estimate the frequency of diaphragmatic paralysis and its related factors after the use of interscalenic, superior trunk or supraclavicular blocks, guided by ultrasound. Methods: Observational study in a follow-up cohort to estimate the incidence of diaphragmatic paralysis and factors associated with its development in patients undergoing upper limb surgery, after blockages above the clavicula guided by ultrasound. Results: 66 patients were included. The most frequent block was the supraclavicular (n = 38, 57.6%) followed by interscalenic (n = 20 30.3%) and finally the upper trunk (n = 10, 15.2%). The average volume was 21.29 ml (median 20 ml, minimum 10 ml and maximum 40 ml). There were no differences in the volume used according to the comparison groups (median of 20 in those with diaphragmatic paralysis versus median of 21 in those who did not develop it). Diaphragmatic paralysis occurred in 39% (n = 26). Of the total number of patients who underwent an interscalenic block (n = 20), the majority had associated diaphragmatic paralysis (n = 14, 70%). Of the patients with upper trunk block (n = 10), 20% developed secondary paralysis (n = 2). Finally, of the total of patients with supraclavicular block (n = 38), 26.3% presented diaphragmatic paralysis. The interscalenic was associated with the development of diaphragmatic paralysis (RR: 6.61, 95% CI 2.07 - 21.10, p = 0.001). Conclusion: the incidence of diaphragmatic paralysis after the use of interscalenic block, superior and supraclavicular trunk was 70%, 20% and 26% respectively, however, unilateral diaphragmatic paralysis generally behaves asymptomatically and was evidenced in our study. The block that is most associated with diaphragmatic paralysis was interscalenic.