What question did this study set out to answer?

To determine the effect of varying volumes of local anaesthetics on the incidence of hemidiaphragmatic paresis after interscalene brachial plexus block.

February 9, 2026Open Access

Incidence of hemi-diaphragmatic paresis with different volumes of local anaesthetics in interscalene brachial plexus block

Key Points

To determine the effect of varying volumes of local anaesthetics on the incidence of hemidiaphragmatic paresis after interscalene brachial plexus block.
Conducted a comparison among three groups receiving 10 ml, 15 ml, and 20 ml of local anaesthetic.
Administered 0.75% ropivacaine with dexmedetomidine.
Measured diaphragm excursion and assessed incidence and severity of diaphragmatic palsy.
Evaluated success rate, onset of sensory blockade, duration of analgesia, and adverse effects.
Significant differences in hemidiaphragmatic paresis between groups (p < 0.001).
Group A had the lowest incidence of paresis.
Faster onset of sensory blockade observed in Group C (4.61 min, p < 0.001).
Postoperative analgesia duration was statistically insignificant across groups.

Abstract

Abstract Background and aims The incidence of diaphragmatic-palsy following interscalene brachial plexus block (IBPB) is almost 100% where the drug volume plays a significant role. We compared the incidence of hemidiaphragmatic paresis and the success rate following IBPB using three different volumes of local anaesthetics. Methods Ninety patients undergoing shoulder and arm surgeries under ultrasound-guided IBPB were randomly allocated into three groups: Group A (10 ml), Group B (15 ml), and Group C (20 ml). The drug administered was 0.75% ropivacaine with 50 mcg dexmedetomidine. The diaphragm excursion was measured before and 30 min after the block on the side of surgery. The incidence of diaphragmatic palsy and its severity were noted. The success rate following block, the onset of sensory blockade, duration of postoperative analgesia, and adverse effects were observed in all three groups. The statistical analysis was done using SPSS software. Results The demographic data, duration of surgery, and success rate following block were statistically insignificant. The hemidiaphragmatic paresis ( 75%) in Group A (29,1,0), Group B (17,13,0), and Group C (15,8,7) was statistically significant ( P value < 0.001). The onset of sensory blockade was Group A (7.06 ± 0.73 min), Group B (6.23 ± 0.72 min), and Group C (4.61 ± 0.63 min) with a P value < 0.001. The duration of postoperative analgesia in Group A (440 ± 48.42 min), Group B (429 ± 44.48 min), and Group C (411 ± 51.37 min) was statistically insignificant ( P value-0.072). Five patients in Group C developed hoarseness of voice postoperatively, which was managed conservatively. Conclusion Low volume ultrasound guided interscalene block (10 ml) is associated with a lower incidence of hemidiaphragmatic paresis with a similar success rate and duration of postoperative analgesia. Higher volume of the drug yields a faster onset of the sensory blockade.

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