Anaes SAQs · Ultrasound-guided peripheral nerve blocks
The interscalene brachial plexus block — technique and the phrenic nerve
Final-viva question on the interscalene block: the interscalene-groove anatomy (C5-C7 roots between scalene muscles), the shoulder-surgery indication and the ulnar sparing, the near-universal phrenic nerve palsy, and the low-volume strategies and diaphragm-sparing alternatives (superior trunk, costoclavicular).
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Prompt
Describe the ultrasound-guided interscalene block: its anatomy, its indications and coverage, and its defining complication. Outline the strategies and alternatives that reduce the phrenic nerve effect.
Question
Describe the ultrasound-guided interscalene block: its anatomy, its indications and coverage, and its defining complication. Outline the strategies and alternatives that reduce the phrenic nerve effect[1][2].
References5ShowHide
- [1]Verbeke AL, Jeanneteau A, Bellet J, et al. The diaphragm-sparing effect of interscalene block with a low-volume of ropivacaine 0.1% vs. 0.5%: A double-blind, controlled, randomised trial. Eur J Anaesthesiol Intensive Care, 2026.PMID 42244823
- [2]da Cunha DF, de Carvalho JPA, de Olinda Ribeiro B, et al. Incidence of hemidiaphragmatic paralysis in superior trunk versus interscalene block upper limb surgeries: a systematic review, meta-analysis, and trial sequential analysis. Anesth Pain Med (Seoul), 2026.PMID 42130052
- [3]Franco CD, Williams JM Ultrasound-Guided Interscalene Block: Reevaluation of the "Stoplight" Sign and Clinical Implications. Reg Anesth Pain Med, 2016.PMID 27203394
- [4]Gamble D, Ebert JR, Shales S, et al. Post-operative pain control in arthroscopic rotator cuff repairs: a prospective, double-blinded, randomized controlled trial comparing interscalene catheters and single-shot blocks. JSES Int, 2026.PMID 41953418
- [5]Fernandez-Martin MT, Massa-Gómez C, Fedriani-Matos J, et al. CARE STUDY: audit of complications of regional anesthesia. A prospective multicenter cohort study. Minerva Anestesiol, 2026.PMID 42240591