Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy: a prospective study

Kocher, Gregor J.; Mauss, Karl; Carboni, Giovanni L.; Hoksch, Beatrix; Kuster, Roland; Ott, Sebastian R.; Schmid, Ralph A. (2013). Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy: a prospective study. The Annals of Thoracic Surgery, 96(6), pp. 2015-2020. Elsevier 10.1016/j.athoracsur.2013.07.006

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BACKGROUND

The issue of phrenic nerve preservation during pneumonectomy is still an unanswered question. So far, its direct effect on immediate postoperative pulmonary lung function has never been evaluated in a prospective trial.

METHODS

We conducted a prospective crossover study including 10 patients undergoing pneumonectomy for lung cancer between July 2011 and July 2012. After written informed consent, all consecutive patients who agreed to take part in the study and in whom preservation of the phrenic nerve during operation was possible, were included in the study. Upon completion of lung resection, a catheter was placed in the proximal paraphrenic tissue on the pericardial surface. After an initial phase of recovery of 5 days all patients underwent ultrasonographic assessment of diaphragmatic motion followed by lung function testing with and without induced phrenic nerve palsy. The controlled, temporary paralysis of the ipsilateral hemidiaphragm was achieved by local administration of lidocaine 1% at a rate of 3 mL/h (30 mg/h) via the above-mentioned catheter.

RESULTS

Temporary phrenic nerve palsy was accomplished in all but 1 patient with suspected catheter dislocation. Spirometry showed a significant decrease in dynamic lung volumes (forced expiratory volume in 1 second and forced vital capacity; p < 0.05) with the paralyzed hemidiaphragm. Blood oxygen saturation levels did not change significantly.

CONCLUSIONS

Our results show that phrenic nerve palsy causes a significant impairment of dynamic lung volumes during the early postoperative period after pneumonectomy. Therefore, in these already compromised patients, intraoperative phrenic nerve injury should be avoided whenever possible.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Thoracic Surgery 04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Pneumology
UniBE Contributor:	Kocher, Gregor, Mauss, Karl, Carboni, Giovanni Luca, Hoksch, Beatrix, Kuster, Roland, Ott, Sebastian Robert, Schmid, Ralph
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1552-6259
Publisher:	Elsevier
Language:	English
Submitter:	Thomas Michael Marti
Date Deposited:	01 May 2014 14:17
Last Modified:	05 Dec 2022 14:29
Publisher DOI:	10.1016/j.athoracsur.2013.07.006
PubMed ID:	24035299
Uncontrolled Keywords:	DLCOcorr (diffusing lung capacity for carbon monoxide, corrected for hemoglobin), FEV1 (forced expiratory volume in 1 second), FVC (forced vital capacity), MRI (magnetic resonance imaging)
URI:	https://boris.unibe.ch/id/eprint/43249