Anaes Vivas · Ultrasound-guided peripheral nerve blocks
Interscalene block — clinical procedure viva
A clinical viva on the interscalene block in a respiratory-compromised patient: the standard technique, the phrenic nerve risk in COPD, the low-volume strategy, and the diaphragm-sparing alternatives (superior trunk, costoclavicular), with the trade-offs explained.
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Prompt
A 55-year-old man with moderate COPD is listed for an arthroscopic rotator cuff repair. Describe how you would plan his regional anaesthesia, including your technique and how you would manage the phrenic nerve risk.
Stimulus
A 55-year-old man with moderate COPD is listed for an arthroscopic rotator cuff repair. Describe how you would plan his regional anaesthesia, including your technique and how you would manage the phrenic nerve risk[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
- [6]Kewalramani R, Vaswani A, Bairwa K, et al. Costoclavicular Brachial Plexus Block for Upper Limb Procedures: A Narrative Review of Efficacy and Safety. Cureus, 2026.PMID 41970126