Hemidiaphragmatic paralysis is initially recognised as postoperative respiratory distress. The subsequent sequential management of the patient following arthroscopic shoulder surgery under interscalene block is described. Ultrasound-guided technique is considered to be the safest for interscalene block. Reducing the volume of anaesthetic used reduces its spread to the phrenic nerve and thus reduces the incidence of hemidiaphragmatic paralysis. Furthermore, a reduction in anaesthetic volume has equivalent analgesic efficacy.
CasatiAFanelliGCedratiVBertiMAldegheriGTorriG1999Pulmonary function changes after interscalene brachial plexus anesthesia with 0.5% and 0.75% ropivacaine: a double-blinded comparison with 2% mepivacaineJournal of the International Anesthesia Research Society83 (3) 587–592
2.
DayalSKyM2009The variation in the roots of the origin of the phrenic nerveJournal of Mahatma Gandhi Institute of Medical Sciences14 (2) 24–27
3.
EdgarRNagdaSHuffmanRNamdariS2012Pulmonary embolism after shoulder arthroscopyOrthopaedics35 (11) e1673–e1676
GrayH1918Anatomy of the human bodyPhildelphia,
Lee and Febiger
6.
GorlinAWarrenL2012Ultrasound-guided interscalene blocksJournal of Ultrasound in Medicine31 (7) 979–983
7.
KelleyWO1950Phrenic nerve paralysis; special consideration of the accessory phrenic nerveThe Journal of Thoracic Surgery19 (6) 923–928
8.
LakeCLBookerPD2005Pediatric cardiac anesthesiaPhilaedelphia,
Lippincott Williams and Wilkins
9.
LeeJHChoSHKimSHChaeWSJinHCLeeJSKimYI2011Ropivacaine for ultrasound-guided interscalene block: 5 ml provides similar analgesia but less phrenic nerve paralysis than 10 mlCanadian Journal of Anaesthesia58 (11) 1001–1006
10.
LehmannLJLoosenGWeissCSchmittnerMD2015Interscalene plexus block versus general anaesthesia for shoulder surgery: a randomized controlled studyEuropean Journal of Orthopaedic Surgery and Traumatology25 (2) 255–261
11.
LiuG-YChenZ-QJiaH-YDaiZGZhangXJ2015The technique comparison of brachial plexus blocks by ultrasound guided with blocks by nerve stimulator guidedInternational Journal of Clinical and Experimental Medicine8 (9) 16699–16703
12.
LongTRWassTBurkleCM2002Perioperative interscalene blockade: an overview of its history and current clinical useJournal of Clinical Anesthesia14 (7) 546–556
13.
McNaughtAShastriUCarmichaelNet al2010Ultrasound reduces the minimum effective local anaesthetic volume compared with peripheral nerve stimulation for interscalene blockBritish Journal of Anaesthesia106 (1) 124–130
14.
MendelsohnAHDeCondeALambertHWet al2011Cervical variations of the phrenic nerveThe Laryngoscope121 (9) 1920–1923
15.
MinettDMNaceJENomuraJT2011Hypoxic respiratory failure due to phrenic nerve palsy from an interscalene brachial plexus block and previously asymptomatic pulmonary embolismCritical Ultrasound Journal3 (2) 105–107
16.
PratesAGJrVasquesLCBordoniLS2015Anatomical variations of the phrenic nerve: an actualized reviewJournal of Morphological Sciences32 (1) 53–56
17.
RenesSHRettigHCGielenMJWilder-SmithOHvan GeffenGJ2009Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresisRegional Anesthesia and Pain Medicine34 (5) 498–502
StundnerOMeissnitzerMBrummettCMet al2016Comparison of tissue distribution, phrenic nerve involvement and epidural spread in standard-vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trialBritish Journal of Anaesthesia116 (3) 405–412
20.
UrmeyWFTaltsKHSharrockNE1991One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonographyAnesthesia & Analgesia72 (4) 498–503
21.
VerelstPvan ZundertA2013Respiratory impact of analgesic strategies for shoulder surgeryRegional Anesthesia and Pain Medicine38 (1) 50–53
