PŮVODNÍ PRÁCE / ORIGINAL PAPER Ultrasound assessment of diaphragmatic movement post selective superior trunk block versus conventional interscalene block in shoulder arthroscopy 10 | ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA / Anest intenziv Med. 2025;36(1):8-14 / www.aimjournal.cz Selective superior trunk block Using the same technique to identify the spotlight sign of the cervical roots and the scalenus muscles, the probe was moved distally to observe the convergence of the C5 and C6 which form the superior trunk. A 22-gauge echogenic needle was advanced from the lateral to the medial region using the in‑plain technique until it reached the lateral border of the superior trunk. Half of the anesthetic solution was administered anteriorly, above the trunk, and the other half was administered posteriorly, below the trunk (a total volume of 15 ml of 0.25% bupivacaine) just prior to the branching of the suprascapular nerve. The procedure time (the time from transducer positioning to the end of local anesthetic injection) and the onset of sensory block were recorded. Every 5 minutes for the first 30 minutes after completing the block, the sensory block intensity was assessed using an 11-point scale (10 representing normal sensation, 0 representing no sensation to cold). A score of 0 was considered to indicate a complete sensory block. Additionally, the motor Tab. 1. Socio-demographic and surgical data of the studied groups Studied variables ISB group (N = 34) STB group (N = 34) Test of sig P value Age / years U Mean ± SD 41.1 ± 14.2 41.2 ± 13.9 0.147 0.883 Median (IQR) 43.0 (27.7–56.2) 39.5 (28.0–57.2) Sex N (%) χ2 Male 21 (61.8) 22 (64.7) 0.063 0.801 Female 13 (38.2) 12 (35.3) BMI t-test Mean ± SD 25.8 ± 0.95 25.7 ± 0.96 0.621 0.537 Median (IQR) 25.9 (25.0–26.6) 25.7 (24.8–26.4) ASA N (%) χ2 I 16 (47.1) 17 (50.0) 0.059 0.808 II 18 (52.9) 17 (50.0) Duration of surgery Mean ± SD 72.9 ± 10.1 73.9±11.3 U Median (IQR) 75.0 (65.0–80.0) 72.5 (65.0–85.0) 0.298 0.766 ISB – interscalene group; STB – selective superior trunk group; U – Mann-Whitney test χ2;chi square test; IQR – Interquartile range Tab. 2. Diaphragmatic movement involvement between the study groups Studied variables ISB group (N = 34) STB group (N = 34) χ2 P value No. % No. % Diaphragmatic paralysis Present 26 76.5 13 38.2 10.1 0.001* Absent 8 23.5 21 61.8 Diaphragmatic movement affection Absent (0–25 %) 8 23.5 21 61.8 12.3 0.002* Partial (> 25 %–75 %) 11 32.4 9 26.4 Complete (> 75 %) 15 44.1 4 11.8 ISB – interscalene group; STB – selective superior trunk group; χ2 – chi square test; *significant Tab. 3. Block characteristics and quality between the study groups Studied variables ISB group (N = 34) STB group (N = 34) Test of sig. P value Performance duration (min) Mean ± SD 6.48 ± 0.69 6.97 ± 0.67 U 0.008* Median (IQR) 6.50 (6.00–7.00) 7.00 (6.50–7.50) 2.46 Onset (min) Mean ± SD 24.7 ± 3.54 23.7 ± 3.31 U 0.244 Median (IQR) 25.0 (21.5–27.0) 23.0 (20.0–27.0) 1.16 Motor block duration (hr) Mean ± SD 12.5 ± 1.92 11.9 ± 1.62 U Median (IQR) 12.5 (11.0–14.0) 12.0 (10.0–13.2) 1.48 0.138 Intraoperative Fentanyl dose (μg/kg) Mean ± SD 0.41 ± 0.74 0.58 ± 0.82 U Median (IQR) 0.00(0.00–1.00) 0.00(0.00–1.00) 0.995 0.320 First call of analgesia (hr) Mean ± SD 9.47 ± 2.13 8.97 ± 1.29 U Median (IQR) 9.50 (8.00–11.2) 9.00 (8.00–10.0) 0.661 0.509 ISB – interscalene group; STBf – selective superior trunk group; U – Mann-Whitney test; IQR – Interquartile range; *significant
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