Ultrasound-Guided Low-Dose Interscalene Brachial Plexus Block Reduces the Incidence of Hemidiaphragmatic Paresis

@article{Renes2009UltrasoundGuidedLI,
  title={Ultrasound-Guided Low-Dose Interscalene Brachial Plexus Block Reduces the Incidence of Hemidiaphragmatic Paresis},
  author={Steven H. Renes and Harald C. Rettig and Mathieu J. M. Gielen and Oliver H. G. Wilder-Smith and Geert-Jan Van Geffen},
  journal={Regional Anesthesia \& Pain Medicine},
  year={2009},
  volume={34},
  pages={498-502 - 498-502}
}
Background and Objectives: Interscalene brachial plexus block is associated with 100% incidence of hemidiaphragmatic paresis as a result of phrenic nerve block. We examined whether an ultrasound (US)-guided interscalene brachial plexus block performed at the level of root C7 versus a nerve stimulation interscalene brachial plexus block, both using 10 mL of ropivacaine 0.75%, resulted in a lower incidence of hemidiaphragmatic paresis. Methods: In a prospective randomized controlled trial, 30… 
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Highly Influential Citations
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Incidence of hemidiaphragmatic paresis after peripheral nerve stimulator versus ultrasound guided interscalene brachial plexus block
TLDR
PNS guided ISBPB with 10 ml of 0.5% bupivacaine is associated with a higher incidence of HDP as compared to US guidedISBPB, and there is no significant difference in quality or duration of analgesia in the two groups.
Ropivacaine for ultrasound-guided interscalene block: 5 mL provides similar analgesia but less phrenic nerve paralysis than 10 mL
TLDR
Interscalene block performed under ultrasound guidance with0.75% ropivacaine 5 mL showed analgesic efficacy similar to that with 0.75%, but with a lower incidence of hemidiaphragmatic paralysis.
The effect of continuous interscalene brachial plexus block with 0.125% bupivacaine vs 0.2% ropivacaine on pain relief, diaphragmatic motility, and ventilatory function.
Ipsilateral hemidiaphragmatic paresis after a supraclavicular and costoclavicular brachial plexus block: A randomised observer blinded study.
TLDR
CostoclavicularBPB produces a lower incidence of ipsilateral PNP than a supraclavicular BPB, and patients undergoing right-sided upper extremity surgery exhibited a positive sniff test, with paradoxical movement of the diaphragm, than in the suprAClavicular group.
Ultrasound guided superficial cervical plexus and interscalene brachial plexus block for clavicular surgery
TLDR
USG guided combined superficial cervical plexus and interscalene brachial plexu block are effective for clavicular surgery without any major complication and may be used in place of general anesthesia or blocks by other techniques.
A fluoroscopic assessment of brachial plexus block by the supraclavicular approach: Have we been overmedicating?
Superior Trunk Block Provides Noninferior Analgesia Compared with Interscalene Brachial Plexus Block in Arthroscopic Shoulder Surgery.
TLDR
The superior trunk block provided noninferior postoperative analgesia compared with interscalene brachial plexus block for up to 24 h after arthroscopic shoulder surgery and resulted in significantly less hemidiaphragmatic paresis.
Comparison of Ultrasound-Guided Supraclavicular, Infraclavicular and Below-C6 Interscalene Brachial Plexus Block for Upper Limb Surgery: A Randomised, Observer-Blinded Study
TLDR
It is indicated that, although interscalene block below the C6 nerve root can provide surgical anaesthesia for forearm and hand surgery, it appears to have a longer onset time than supra- and infraclavicular approaches and an unacceptable incidence of phrenic nerve palsy.
The estimation of minimum effective volume of 0.5% ropivacaine in ultrasound-guided interscalene brachial plexus nerve block: A clinical trial
TLDR
This study observes that surgical anesthesia can be accomplished with 8.5% ropivacaine with ultrasound-guided ISB with multiple injection technique, without clinical deterioration in block onset and duration of analgesia.
Combined Suprascapular/ Supraclavicular versus Interscalene Ultrasound Guided Nerve Blocks for Shoulder
TLDR
Comparison between the two study groups as regards the success rate of the ultrasound-guided block to perform shoulder arthroscopy was statistically non-significant.
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References

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TLDR
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TLDR
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TLDR
Interscalene block probably should not be performed in patients who are dependent on intact diaphragmatic function and in those patients unable to tolerate a 25% reduction in pulmonary function, because of the large decreases in all pulmonary function variables.
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TLDR
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TLDR
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