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Diaphragmatic paralysis in obese patients in arthroscopic shoulder surgery: consequences and causes

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Abstract

Purpose

Ambulatory process in arthroscopic shoulder surgery has boomed over past decades. Some anesthetic techniques such as interscalene block (ISB) and its surrogates are associated with diaphragmatic paralysis and might compromise outpatient procedure.

Hypothesis

This study aims to assess consequences of diaphragmatic paralysis in obese patients.

Methods

This prospective observational study screened patients with body mass index (BMI) ≥ 30 kg/m2 undergoing acromioplasty or supraspinatus tendon repair. Surgery was performed using brachial plexus block, and the method of brachial plexus block was left at the discretion of attending anesthesiologists. Post-operative hemidiaphragmatic paralysis was evaluated using M-mode ultrasonography and its consequences on patient ventilation were assessed: occurrence of hypoxic episode defined as oxygen saturation less than 90% (by pulse oximeter) in room air, dyspnea and failure of ambulatory procedure. Causes of diaphragmatic paralysis were also analyzed.

Results

Ninety-one patients were screened, 82 patients were included in this study and 37 patients (45%) presented diaphragmatic paralysis. Compared to patients without diaphragmatic paralysis, diaphragmatic paralysis was associated with dyspnea [10 (27%) versus 1 (2%); p = 0.0019], occurrence of patients presenting at least one hypoxic episode [6 (16%) versus 1 (2%); p = 0.02] and failure of ambulatory process [10 (27%) versus 1 (2%); p = 0.009]. The combination of axillary and suprascapular nerve blocks, but also low volume ISB, was found to be protective against diaphragmatic paralysis when compared to high volume ISB [Odds ratios 0.0019 (0.001–0.026) and 0.0482 (0.008–0.27), respectively; p < 0.001].

Conclusion

In patients with BMI ≥ 30 kg/m2 undergoing arthroscopic shoulder surgery, diaphragmatic paralysis is associated with dyspnea, occurrence of hypoxic episodes and failure of ambulatory procedure. High volume ISB and also, to a lesser extent, low volume ISB were found to be responsible for diaphragmatic paralysis.

Trial registry number

Registration n° 2014-202.

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Acknowledgements

Dr Mailles helped us to draft the manuscript. Dr Duport performed all surgical procedures.

Author information

Authors and Affiliations

  1. Department of Anesthesia, Clinique Medipôle Garonne, 31036, Toulouse, France

    Philippe Marty, Bertrand Basset, Constance Marquis, Martine Chaubard, Mehdi Merouani, Olivier Rontes & Alain Delbos

  2. Département Anesthésie-Réanimation, Hôpital Pierre-Paul Riquet, CHU Purpan, 31059, Toulouse, France

    Fabrice Ferré

  3. Department of Intensive Care, Centre hospitalier Hôtel-Dieu, Narbonne, France

    Benoit Bataille

Authors
  1. Philippe Marty
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  2. Fabrice Ferré
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  3. Bertrand Basset
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  4. Constance Marquis
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  5. Benoit Bataille
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  6. Martine Chaubard
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  7. Mehdi Merouani
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  8. Olivier Rontes
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  9. Alain Delbos
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Contributions

PM and BB performed all measurements and wrote the manuscript. MD performed all surgical procedures. AD and OR participated in the design of the study. BB performed the statistical analysis. CM, MM and MC participated in its design and coordination and helped to draft the manuscript. FF helped us to draft the revised manuscript. His expertise in this area and in publication has been helpful to improve the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Philippe Marty.

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Conflict of interest

This work should be attributed to the Department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France. Support was provided solely from institutional and department sources from department of Anesthesiology, Clinique Medipole Garonne, Toulouse, France. Authors have not disclosed any potential conflicts of interest.

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Marty, P., Ferré, F., Basset, B. et al. Diaphragmatic paralysis in obese patients in arthroscopic shoulder surgery: consequences and causes. J Anesth 32, 333–340 (2018). https://doi.org/10.1007/s00540-018-2477-9

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  • DOI: https://doi.org/10.1007/s00540-018-2477-9

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