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ObjectiveTo evaluate the incidence of the hemidiaphragmatic paresis after inter Sterno-Cleido-Mastoid (inter-SCM) block.Study designProspective, comparative, single blind study.Patients16 patients ASA I-II.MethodsThe diaphragmatic paresis was measured by a radiologist unaware of the technique used and operated side. It was determined by the diaphragmatic excursion (DE) on double-exposure chest radiography, obtained preoperatively and postoperatively (DE-pre, DE-post) for the ipsilateral and controlateral side of the inter-SCM block. All the patients were given 20 mL 0.5% bupivacaine 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 into 2 groups. Group 1: injection via the needle after eliciting flexion of fingers, or via a catheter into infraclavicular position; group 2: injection via the needle after eliciting contraction of deltoid, or elbow flexion, or via a supraclavicular catheter.ResultsAll the patients had satisfactory block. The ipsilateral DE was decreased after injection of anesthetics in group 2 (P < 0.001) while it remained unchanged in group 1.ConclusionThe diaphragmatic paresis is avoidable with the inter-SCM block if and only if the anesthetic solution is injected via the needle after stimulating flexion of fingers or via a catheter into infraclavicular position.

Original publication




Journal article


Annales francaises d'anesthesie et de reanimation

Publication Date





517 - 522


Service d'anesthésie-réanimation chirurgicale, Hôtel-Dieu, Nantes, France.


Fingers, Neck Muscles, Brachial Plexus, Phrenic Nerve, Humans, Respiratory Paralysis, Lidocaine, Bupivacaine, Anesthetics, Local, Nerve Block, Injections, Intramuscular, Prospective Studies, Single-Blind Method, Posture, Adult, Middle Aged, Female, Male