Title: Does cervical epidural anesthesia affect pulmonary function?

T. Sheikh*, T. C. Kao, K. Frey, M. Morales, R. A. Stevens

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Introduction: Cervical epidural anesthesia has been used to provide anesthesia for a variety of surgical procedures including carotid endarterectomy, breast surgery, and shoulder surgery. Since anesthesia of the cervical dermatomes C3-C5 may occur, one might expect to see a block of the phrenic nerve during cervical epidural anesthesia. To date the effect of this anesthetic technique upon pulmonary function has not been reported. METHODS: After IRB approval and written informed consent, 15 adult patients (7 males, 8 females) aged 18-75 years and scheduled for carotid endarterectomy, breast surgery, or cervical epidural steroid injection were studied. Cervical epidural anesthesia was performed in the sitting position with Tuohy needle insertion at C7/T1. A total of 15 ml 2% lidocaine with epinephrine 1:200,000 were injected. Pulmonary function testing was performed in the supine position. The following parameters were measured: Sa02 while breathing room air, Forced Expiratory Volume in 1 second (FEV1) , Forced Vital Capacity (FVC), Negative Inspiratory Force (NIF-cm H2O), and maximum cephalad dermatomal extent of analgesia. Median levels are reported. Testing was done prior to anesthesia, and at 5, 10, 20, 30, and 40 minutes after epidural injection. Results are expressed as mean ± SD (Sa02, NIF) or mean ±SD % of pre-block values (FEV1, FVC) . T-test was used to test for differences, P < 0.05 was considered significant. RESULTS : Pre-block 5 min %pre 10 min %pre 20 min %pre 30 min %pre 40 min %pre FEV1 2.49±.72 98±9 91±14 85±17* 88±.11* 87+10* FVC 2.70±.78 98±10 90±16 84±18* 86±15* 86±12* NIF -90±30 -90±10 -90±20 -9Q±20 -90±20 -90±40 SaO2 98% 98% 95% 97% 97% 98% analgesia C4 C3 C3 C3 C3 P < 0.05 compared to pre-block DISCUSSION: The small decrease in respiratory function observed from 20-40 minutes after cervical epidural lidocaine 300 mg is clinically insignificant in normal patients. Despite analgesia of the cervical dermatomes, the blockade of the phrenic nerve is incomplete. Larger doses of local anesthetic could have a more profound effect upon phrenic nerve function.

Original languageEnglish
Pages (from-to)3
Number of pages1
JournalRegional Anesthesia
Issue number2 SUPPL.
StatePublished - 1997
Externally publishedYes


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