Although this approach is safe in older patients with comorbid conditions associated mainly with a history of lung disease, the possibility of this complication occurring also in other ambulatory patients must not be overlooked. 1. Chin KJ, Singh M, Velayutham V, Chee V. Infraclavicular brachial plexus block for regional anaesthesia of the lower arm Review. The Cochrane Collaboration. Publicado en: The Cochrane Library 2010, Issue 3. 2. Vincent M, Fourcade O, Idabouk L, Claassen J, Chassery C, Nguyen L, et al. Infraclavicular brachial plexus block versus humeral block in trauma patients: a comparison of patient comfort. Anesthesia and Analgesia 2006;102:912-6. 3. Urmey WF, McDonald M. Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics. Anesthesia and Analgesia 1992;74352-7. 4. Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesthesia and analgesia 1991;72:498-503. 5. Bollini CA, Wikinski JA. Anatomical review of the brachial plexus. Techniques in Regional Anesthesia and Pain Management 2006;10:69-78. 6. Stadlmeyer W, Neubauer J, Finkl RO, Groh J. Unilateral phrenic nerve paralysis after vertical infraclavicular plexus block. Anaesthesist 2000;49:1030-3. 7. Gentili ME, Deleuze A, Estebe J, Lebourg M, Ecoffey C. Severe respiratory failure after infraclavicular block with 0.75% ropivacaine: a case report. Journal of Clinical Anesthesia 2002;14:459-61. 8. Rettig HC, Gielen MJ, Boersma E, Klein J, Groen GJ. Vertical infraclavicular block of the brachial plexus: effects on hemidiaphragmatic movement and ventilatory function. Regional Anesthesia and Pain Medicine 2005;306:529-35. 9. Rodriguez J, Bárcena M, Rodríguez V, Aneiros F, Álvarez J. Infraclavicular Brachial Plexus Block Effects on Respiratory Function and Extent of the Block. Regional Anesthesia and Pain Medicine. 1998;236:564-68. 10. Jandart C, Gentili ME, Girard F, Ecoffey C, Heck M, Laxenaire MC, et al. Infraclavicular block with lateral approach and nerve stimulation: extent of anesthesia and adverse effects. Regional Anesthesia and Pain Medicine 2002;27:37-42. 11. Salengros J, Jacquot C, Hesbois A, Vandesteene A, Engelman E, Pandin P. Delayed Horner’s syndrome during a continuous infraclavicular brachial plexus block. Journal of Clinical Anesthesia 2007;19:57-9. 12. Grueso R, Sanin A, Bonilla AJ, García A, Cubillos J. Comparación entre la técnica de multi-inyección y la inyección única con localización del nervio mediano en el bloqueo infraclavicular para cirugía del miembro superior. Rev. Colomb. Anestesiol. 2010;381: 22-32. 13. Rodríguez J, Bárcena M, Alvarez J. Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block. Regional Anesthesia and Pain Medicine 2003;281:33-6. 14. Dullenkopf A, Blumenthal S, Theodorou P, Roos J, Perschak H, Borgeat A. Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block. Regional Anesthesia and Pain Medicine. 2004;292:110-4. 15. Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, Van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Regional Anesthesia and Pain Medicine 2009;345:498-502. 16. Renes SH, Spoormans HH, Gielen MJ, Rettig HC, Van Geffen GJ. Hemidiaphragmatic paresis can be avoided in ultrasound-guided supraclavicular brachial plexus block. Regional Anesthesia and Pain Medicine 2009;346:595-9.
Si bien es un abordaje más seguro en pacientes de mayor edad con comorbilidades asociadas principalmente a antecedentes de enfermedades pulmonares, no se debe dejar de contemplar la posibilidad de que esta complicación aparezca también en otros pacientes ambulatorios.