Reactions 450 - 8 May 1993

★Bupivacaine

First report of phrenic nerve paralysis afterinterpleural analgesia: case report

Elevation of the right hemidiaphragm and reductions in FEVsub(1) and FVC occurred in a 55-year-old woman after a firstdose of interpleural bupivacaine 0.5% 20ml was administeredover 5 min for analgesia following cholecystectomy. Thewoman received 5 interpleural doses of bupivacaine within48h of surgery. On the fourth day after surgery, her FEVsub(1), FVC and chest x-ray had returned to normal and shewas discharged from hospital the next day.

Author comment:‘The most likely cause of the raised righthemidiaphragm was phrenic nerve paralysis from theinterpleural analgesia. Failure to obtain an improvement in thepatient’s FEV sub(1) and FVC following effective analgesiawould seem to support this.’ The concentration and volume ofbupivacaine may also have contributed to the paralysis, and itis possible that the effect would not have occurred at a lowerconcentrationLauder GR. Interpleural analgesia and phrenic nerve paralysis. Anaesthesia 48:315-316, Apr 1993 - England 800195065

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Reactions 8 May 1993 No. 4500114-9954/10/0450-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved