This study is aims to compare between combined suprascapular and axillary nerve blocks versus interscalene nerve block regarding phrenic nerve affection assessed by ultrasound guided diaphragmatic excursion in shoulder arthroscopy surgeries.

Interscalene approach of brachial plexus nerve block is recognized as the gold standard technique for postoperative pain control after shoulder arthroscopy surgeries . However, it is associated with major adverse effects and possibly critical complications including phrenic nerve affection. Combined suprascapular and axillary nerve blocks are considered to be a safe and effective alternative to interscalene nerve block for shoulder surgery. Futher studies had been done regarding postoperative analgesia after shoulder arthroscopy surgeries using intersalene nerve block versus suprascapular and axillary nerve blocks.

In this study, we will Compare between combined suprascapular and axillary nerve blocks vs interscalene nerve block regarding objective phrenic nerve affection known as a serious complication of interscalene nerve block.

Inclusion Criteria:

• Patients aged between 18 - 60 years old.
• Both sexes.
• ASA physical status classes I - II.
• Body mass index: 18-35 kg/ m2.

Exclusion Criteria:

• Infection at site of injection.
• Psychiatric illness.
• Central Nervous System Diseases like (epilepsy, stroke …etc.) or neurological disease affecting patient's upper limb.
• Dependence on opiates and psycho-dynamic medications.
• Moderate to severe pulmonary disease.
• Coagulopathy and bleeding disorders.
• Allergies to drug used (Bupivacaine 0.5%).
• Previous surgery at site of injection and history of radiotherapy.