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Interscalene brachial plexus block is a commonly chosen anesthetic technique for shoulder and proximal arm surgery yet it carry several risks including phrenic nerve block.
Researchers assumed that slow administration of local anesthetic would reduce incidence of phrenic nerve block
patients will be randomly allocated into one of 2 groups ( single shot group) and slow administration group . single shot will receive a 10 ml bolus of 0.5% bupivacaine the other group will receive 10 ml 0.5 % bupivacaine over 10 minutes (at a rate of 1ml/minute) using syringe pump An experienced operator who will be blinded to method of administration will conducted diaphragmatic excursion of ipsilateral hemidiaphragm using curved probe at baseline and at 10 minutes interval for 30 minutes Complete phrenic will be defined as 75% or more reduction in DE, while partial failure as 25%-50% reduction in DE
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single shot | Active Comparator | They will receive a 10 ml of 0.5 % bupivacaine as a single shot |
|
| Slow administration group | Active Comparator | They will receive 10 ml of 0.5% bupivacaine over 10 minutes |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Diaphragmatic excursion evaluation | Device | They will receive 10 ml of 0.5% bupivacaine over 10 minutes |
|
| Measure | Description | Time Frame |
|---|---|---|
| Complete phrenic nerve block defined as > 75% reduction in diaphragmatic excursion | defined as > 75% reduction in diaphragmatic excursion | baseline and 30 minutes after the block |
| Measure | Description | Time Frame |
|---|---|---|
| partial phrenic block | 25-50% reduction in DE | baseline and 30 minutes after the block |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Cairo University | Cairo | Giza Governorate | 6890 | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 19920426 | Background | Renes SH, Rettig HC, Gielen MJ, Wilder-Smith OH, van Geffen GJ. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med. 2009 Sep-Oct;34(5):498-502. doi: 10.1097/AAP.0b013e3181b49256. | |
| 28025374 | Background | Wong AK, Keeney LG, Chen L, Williams R, Liu J, Elkassabany NM. Effect of Local Anesthetic Concentration (0.2% vs 0.1% Ropivacaine) on Pulmonary Function, and Analgesia After Ultrasound-Guided Interscalene Brachial Plexus Block: A Randomized Controlled Study. Pain Med. 2016 Dec;17(12):2397-2403. doi: 10.1093/pm/pnw057. Epub 2016 Apr 13. |
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Data will be available from corresponding author upon reasonable request
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patients will be randomly allocated into 2 groups : single shot group and slow infusion group
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| 7486085 | Result | Fujimura N, Namba H, Tsunoda K, Kawamata T, Taki K, Igarasi M, Namiki A. Effect of hemidiaphragmatic paresis caused by interscalene brachial plexus block on breathing pattern, chest wall mechanics, and arterial blood gases. Anesth Analg. 1995 Nov;81(5):962-6. doi: 10.1097/00000539-199511000-00012. |
| 21697691 | Result | Verelst P, van Zundert A. Incidence of phrenic nerve block after interscalene brachial plexus block. Reg Anesth Pain Med. 2011 Jul-Aug;36(4):411-2; author reply 412. doi: 10.1097/AAP.0b013e318219e19d. No abstract available. |
| 16282408 | Result | Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005 Nov 12;331(7525):1124-8. doi: 10.1136/bmj.331.7525.1124. No abstract available. |
| 9924205 | Result | Urwin M, Symmons D, Allison T, Brammah T, Busby H, Roxby M, Simmons A, Williams G. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis. 1998 Nov;57(11):649-55. doi: 10.1136/ard.57.11.649. |
| 41207378 | Derived | Helmy MA, Gamal B, Milad LM, El Adawy A, Ibrahim F, Kasem SMM, Mostafa H. Single-shot versus slow infusion interscalene block and its impact on diaphragmatic function in patients undergoing shoulder surgery, a double blind randomized controlled trial. Anaesth Crit Care Pain Med. 2026 Jul;45(4):101668. doi: 10.1016/j.accpm.2025.101668. Epub 2025 Nov 7. |