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For the cervical surgical technique, the phrenic nerve is approached via a small (~5 cm) incision slightly above, and midline to, the clavic. The phrenic nerve is then isolated under the scalenus anticus muscle. For the thoracic surgical technique, a small (~5 cm) incisions over the 2nd or 3rd intercostal space.
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The phrenic nerve must be identified during thoracic surgery and preserved. To confirm the identity of the phrenic nerve, a doctor may gently manipulate it to elicit a dartle (diaphragmatic startle) response. [7] The right phrenic nerve may be crushed by the vena cava clamp during liver transplantation. [8]
The symptoms of nerve injury in the early 1900s were called nerve palsy (today neuropathy or neuritis are more common terms). [50] The concept of injuries causing nerve palsy was understood at that time. [49] For example, wrist fractures were known to be a cause of nerve palsy through compression, and this could be treated by liberating the nerve.
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The axillary block is particularly useful in providing anesthesia and postoperative analgesia for surgery to the elbow, forearm, wrist, and hand. The axillary block is also the safest of the four main approaches to the brachial plexus, as it does not risk paresis of the phrenic nerve, nor does it have the potential to cause pneumothorax. [12]
The use of a nerve decompression or neurectomy to treat nerve pain along the lateral femoral cutaneous nerve is a firmly established surgical treatment. [ 24 ] [ 25 ] However, the more effective treatment between a decompression and neurectomy is still being researched.