Related Experiment Video
Updated: Aug 25, 2026

Osteopathic Manipulative Treatment as a Useful Adjunctive Tool for Pneumonia
Published on: May 6, 2014
Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block
Alexander Dullenkopf1, Stephan Blumenthal, Panagiotis Theodorou
1Department of Anesthesiology, Orthopedic University Clinic Zurich/Balgrist, Zurich, Switzerland.
Background:
The effects of the infraclavicular plexus block using the modified Raj approach on diaphragm and respiratory function have not been investigated.
Methods:
After obtaining approval of the local ethics committee and written informed consent, 20 patients, scheduled for surgery of the forearm, wrist, or hand were prospectively included. Infraclavicular block was performed using the modified Raj technique with 40 to 50 mL ropivacaine 0.5%. Forced diaphragmatic excursion (DE), vital capacity (VC), first-second forced expiratory volume (FEV(1)), and peak expiratory flow rate (PEFR) were assessed the day before surgery and 30 and 360 minutes after blocks, respectively.
Results:
There was no significant difference between pre- and postblock values, neither for DE (5.6 +/- 1.0 cm before the block, 5.2 +/- 1.4 cm 30 minutes after the block, and 5.7 +/- 1.4 cm 360 minutes after the block) nor for VC (3.2 +/- 0.8 L before the block, 3.1 +/- 0.9 L 30 minutes after the block, and 3.0 +/- 0.9 L 360 minutes after the block), FEV(1) (2.8 +/- 0.9 L before the block, 2.8 +/- 0.9 L 30 minutes after the block, and 2.7 +/- 0.9 L 360 minutes after the block), or PEFR (378 +/- 116 L/min before the block, 355 +/- 110 L/min 30 minutes after the block, and 364 +/- 116 L/min 360 minutes after the block).
Conclusion:
Infraclavicular block using the modified Raj technique did not interfere with diaphragmatic excursion or respiratory function.
Related Concept Videos
Physical Assessment of the Respiratory Tract II: Palpation
Thoracic Palpation
Thoracic palpation detects tenderness, masses, lesions, respiratory excursions, and vocal fremitus. The nurse assesses...
Mechanism of Breathing III: The Accessory Muscles
The respiratory system is a complex network that relies on primary respiratory muscles like the diaphragm, but also involves accessory muscles to enhance lung expansion and airflow during both inhalation and exhalation.
Enhancing Inhalation with Accessory Muscles:
Accessory muscles such as the sternocleidomastoid, scalene, intercostal, and abdominal muscles are crucial when additional respiratory effort is required, such as during deep...
Respiratory System Abnormal Finding I: Inspection and Percussion
Inspection Findings
During an inspection, several findings may suggest the presence of respiratory distress or disease. Pursed-lip breathing, where exhalation is slowed by...
Respiratory System Abnormal Finding II: Palpation and Auscultation
Palpation Findings
During a respiratory assessment, palpation can reveal several vital abnormalities:
Physical Assessment of the Respiratory Tract III: Percussion
Percussion in Respiratory Assessment
Percussion evaluates underlying tissue composition with audible and tactile vibrations,...
Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like asthma or COPD,...
