Diaphragmatic excursion after inter sterno-cleidomastoid block, according to the injection site.

Objective: To evaluate the incidence of the hemidiaphragmatic paresis after inter Sterno-Cleido-Mastoid (inter-SCM) block. Study design: Prospective, comparative, single blind study. Patients: 16 patients ASA I-II. Methods: The diaphragmatic paresis was mesured by a radiologist unaware of the technique used and operated side. It was determined by the diaphragmati c excursion (DE) on double-exposure chest radiography, obtained preoperativ ely and postoperatively (DE-pre, DE-post) for the ipsilateral and controlat eral side of the inter-SCM block. All the patients were given 20 mt 0.5% bu pivacaine plus 20 mL 2% lidocaine both with epinephrine. These anesthetics were injected via the stimuling needle or via the catheter after opacified radiological control of the catheter position. The patients were divided in to 2 groups. Group 1: injection via the needle after eliciting flexion of f ingers, or via a catheter into infraclavicular position; group 2. injection via the needle after eliciting contraction of deltoid, or elbow flexion, o r via a supraclavicular catheter. Results: All the patients had satisfactory block. The ipsilateral DE was de creased after injection of anesthetics in group 2 (P < 0.001) while it rema ined unchanged in groupe 1 Conclusion: The diaphragmatic paresis is avoidable with the inter-SCM block if and only if the anesthetic solution is injected via the needle after st imulating flexion of fingers or via a catheter into infraclavicular positio n. (C) 2000 Editions scientifiques et medicales Elsevier SAS.