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The Effect of Continuous Interscalene Brachial Plexus Block with 0.125% Bupivacaine Plus Fentanyl on Diaphragmatic Motility and Ventilatory Function
  1. Pertti Pere, M.D.
  1. From the Department of Anesthesia, 4th Department of Surgery, Helsinki University Central Hospital, Kasarmikatu, Helsinki, Finland.
  1. Address all correspondence and reprint requests to Pertti Pere, M.D., Department of Anesthesia, 4th Department of Surgery, Helsinki University Central Hospital, Kasarmikatu 11-13, 00130 Helsinki, Finland.


Background and Objectives. Continuous interscalene brachial plexus block with 0.25% bupivacaine decreases diaphragmatic motility and ventilatory function. The author studied the effects of 0.125% bupivacaine with and without fentanyl.

Methods. Forty patients who were to undergo shoulder surgery were given an interscalene brachial plexus block using 20-28 ml 0.75% bupivacaine plus epinephrine. In random order, 10 patients then had a 24-hour continuous block with 0.125% bupivacaine (BUPI) (5-9 ml/h). Nine patients had an additional s.c. infusion of fentanyl (F-SC) (15-27 μg/h) and 10 the same dose of fentanyl with the bupivacaine infusion (F-PLX). Ten patients had a single block (PLX) for minor surgery. Spirometry, double-exposure chest radiography, pulse oximetric hemoglobin saturation and maximal airway pressures were measured.

Results. Postoperatively, BUPI patients were given, on average, 1.2, F-SC patients 0.7, and F-PLX patients 0.4 doses of oxycodone in 24 hours (not significant). Average ipsilateral diaphragmatic motility was reduced to 8% in F-PLX group ( p < 0.01) and to 19-30% in the other groups ( p < 0.05). At 24 hours, average motility in BUPI, F-SC, F-PLX and PLX groups was 54, 48, 31 and 91%, respectively. In all groups FVC, FEV1 and PEF were reduced by 20-40% at 3 hours ( p < 0.001). At 8 and 24 hours, FVC and FEV1 were in F-SC and F-PLX groups significantly lower ( p < 0.05) than in PLX group.

Conclusions. Use of 0.125% bupivacaine for continuous interscalene block did not prevent a deterioration of diaphragmatic motility and ventilatory function. Coinfusion of fentanyl did not significantly potentiate the block.

  • anesthetics
  • local
  • bupivacaine
  • anesthetic techniques
  • brachial plexus block
  • opioid analgesics
  • fentanyl.

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  • This study was presented at the ESRA/ASRA 3rd Joint Congress in Brussels, June 9-12, 1992.

    The author thanks Drs. Mikko Pitkänen, Per Rosenberg, and Marjatta Tuominen for valuable discussions.