PŮVODNÍ PRÁCE / ORIGINAL PAPER Ultrasound assessment of diaphragmatic movement post selective superior trunk block versus conventional interscalene block in shoulder arthroscopy | 13 / Anest intenziv Med. 2025;36(1):8-14 / ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA www.aimjournal.cz ed by a well‑defined connective sheath without any anatomical variation, unlike the hypoechoic C5 and C6 roots which are enveloped by a thin facial layer and have anatomical variation in their course [4, 20, 21]. The opioid‑sparing effect of the interscalene block was maintained in the superior trunk group due to the absence of any difference in opioid consumption or pain scores during the observation period. The STB is a more proximal block approach to the brachial plexus, which is likely the reason for this finding. It offers extensive coverage [22]. The main strengths of this trial were the limited number of papers in this field and our primary outcome, diaphragmatic movement involvement, which reflects the true impact of both blocks. Fortunately, the study was conducted on ASA I and II patients, none of whom exhibited respiratory compromise, either clinically through symptoms like shortness of breath or in terms of respirometric parameters. However, our trial is limited by the block performance done by a single experienced anesthesiologist in a single center, which can decrease the performance bias and increase the validity of the trial but limits the generalizability of the findings. Finally, we assessed perioperative analgesia only and not surgical anesthesia which is more important in patients with pre ‑existing pulmonary diseases. Conclusion We found that, compared with conventional ISB, selective STB was associated with a lower incidence of HDP and provided equipotent effective postoperative analgesia. Further studies are required to assess STB performance difficulty and determine the appropriate local anesthetic dose that decreases diaphragmatic paralysis and provides better analgesia. PROHLÁŠENÍ AUTORŮ: Declaration of authenticity: The paper is original, has not been published elsewhere, and has not been submitted to peer‑review in another medium. Conflict of interest: The authors declare that they have no conflict of interest. Author contribution: WAS designed the study and performed the practical part of the study. AS shared the practical part and collected and analysed the data with WR. NA completed the primary writing. AAM revised the manuscript for proofreading. All the authors have read and approved the final manuscript submitted to the Anaesthesiology and Intensive Care Medicine journal. Funding: None. Acknowledgement: N/A. Registration: It was prospectively registered at www.pactr.org (PACTR 202202483221034). Ethics committee consideration: (IRB approval number 2/2022 ANES 37), Menoufia University Hospital, Menoufia, Egypt on 20 February 2022. REFERENCES 1. Elkassabany NM, Wang A, Ochroch J, Mattera M, Liu J, Kuntz A. Improved Quality of Recovery from Ambulatory Shoulder Surgery After Implementation of a Multimodal Perioperative Pain Management Protocol. Pain Med. 2019 May 1;20(5):1012-1019. doi: 10.1093/ pm/pny152. PMID: 30113685. 2. Kim DH, Lin Y, Beathe JC, Liu J, Oxendine JA, Haskins SC, et al. Superior Trunk Block: A Phrenic-sparing Alternative to the Interscalene Block: A Randomized Controlled Trial. Anesthesiology. 2019 Sep;131(3):521-533. doi: 10.1097/ALN.0000000000002841. PMID: 31283740. 3. Aliste J, Bravo D, Layera S, Fernández D, Jara Á, Maccioni C, et al. Randomized comparison between interscalene and costoclavicular blocks for arthroscopic shoulder surgery. Reg Anesth Pain Med. 2019 Jan 11:rapm-2018-100055. doi: 10.1136/rapm-2018-100055. Epub ahead of print. PMID: 30635497. 4. Burckett-St Laurent D, Chan V, Chin KJ. Refining the ultrasound-guided interscalene brachial plexus block: the superior trunk approach. Can J Anaesth. 2014 Dec;61(12):1098-102. doi: 10.1007/s12630-014-0237-3. Epub 2014 Sep 11. PMID: 25208976. Tab. 4. Complications between the study groups Studied variables ISB group (N = 34) STB group (N = 34) FE P value No. % No. % Epidural anesthesia Yes 0 0 0 0 0.00 0.001* No 34 100 34 100 Horner syndrome Yes 0 0 0 0 0.00 0.002* No 34 100 34 100 Hematoma Yes 0 0 0 0 0.00 1.00 No 34 100 34 100 Pneumothorax Yes 0 0 0 0 0.00 1.00 No 34 100 34 100 Hoarseness Yes 0 0 0 0 0.00 1.00 No 34 100 34 100 Neural injury Yes 0 0 0 0 0.00 1.00 No 34 100 34 100 Hand grip weakness at 24 hr Yes 2 5.90 0 0 0.348 0.554 No 32 94.1 34 100 ISB – interscalene group; STB – selective superior trunk group; FE – Fisher exact test
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