Anest. intenziv. Med. 2025;36(1):8-14 | DOI: 10.36290/aim.2025.012

Ultrasound assessment of diaphragmatic movement post selective superior trunk block versus conventional interscalene block in shoulder arthroscopyOriginal Article

Sultan W. A., Metwally A. A., Soliman A. M., Mahdy W., Afify N.
Anesthesia and Intensive Care Department, Faculty of Medicine, Menoufia University, Egypt

Study objective: Our aim was to evaluate the incidence of hemidiaphragmatic paralysis after selective superior trunk block compared to conventional interscalene block. Study design: A prospective double­‑blinded randomized controlled trial. Setting: University Hospital of Faculty of Medicine. Material and Method: Sixty­‑eight patients who were scheduled for shoulder arthroscopy were divided into two equal groups. The interscalene group received ultrasound­‑guided interscalene block and the superior trunk group received ultrasound­‑guided selective superior trunk block. A total volume of 15 ml of 0.25% bupivacaine was injected in both techniques. Incidence of hemidiaphragmatic paralysis was our primary outcome. Block characteristics (procedure duration, onset of sensory block, and duration of motor block), block quality (intraoperative hemodynamic parameters, intraoperative fentanyl consumption, and time to the first call of analgesia), and incidence of complications were assessed and recorded.

Results: The incidence of hemidiaphragmatic paralysis in the interscalene group was significantly greater than that in the selective superior trunk block (76.5% vs. 38.2%) with a p value of 0.001, and it was completely affected in 44.1% of the interscalene group compared to 11.8% of the selective superior trunk block group with a p value of 0.002. The procedure duration (min) was significantly greater in the selective superior trunk group than in the interscalene group (6.97±0.67) vs. (6.48±0.69), respectively, with no significant differences in the remaining block characteristics and block quality parameters as well. No significant complications were reported.

Conclusion: Although US­‑guided interscalene and selective superior trunk blocks addressed an equivalent quality, selective superior trunk block was associated with a significantly lower incidence of hemidiaphragmatic paralysis.

Keywords: shoulder arthroscopy, interscalene block, selective superior trunk block

Received: November 22, 2024; Revised: March 26, 2025; Accepted: April 1, 2025; Prepublished online: April 14, 2025; Published: April 28, 2025  Show citation

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Sultan WA, Metwally AA, Soliman AM, Mahdy W, Afify N. Ultrasound assessment of diaphragmatic movement post selective superior trunk block versus conventional interscalene block in shoulder arthroscopy. Anest. intenziv. Med. 2025;36(1):8-14. doi: 10.36290/aim.2025.012.
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