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October 12, 2025Regional Anesthesia & Pain Medicine

Phrenic Nerve Block Caused by Interscalene Brachial Plexus Block: Effects of Digital Pressure and a Low Volume of Local Anesthetic

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Authors

XSXavier Sala‐BlanchHospital Clínic de BarcelonaJLJ. R. LázaroJCJ. Correa

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Implication

Randomized trial shows no reduction in phrenic nerve block incidence in patients receiving ISB, suggesting local anesthetic volume and digital pressure are ineffective.

Key Points

  • Interscalene brachial plexus block caused diaphragmatic paralysis in all patients evaluated, regardless of anesthetic volume used.
  • Functional residual capacity decreased by 34% for 40 mL and 37% for 20 mL local anesthetic, indicating similar effects on breathing.
  • The study involved twenty healthy patients undergoing ISB for upper extremity surgery, assessing the impact of volume and pressure.
  • Results indicate that even with reduced volume and digital pressure, cervical block spread and diaphragm impact were unchanged.

Cite This Study

Sala‐Blanch et al. (1999) studied this question.

synapsesocial.com/papers/68eb6f7ceea689731b3006afhttps://doi.org/10.1136/rapm-00115550-199924030-00009
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Ultrasound-guided Assessment of Phrenic Nerve Involvement after Interscalene Brachial Plexus Block2025
  2. 2Incidence of hemi-diaphragmatic paresis with different volumes of local anaesthetics in interscalene brachial plexus block2026
  3. 3Respiratory effects and analgesic efficacy of different local anesthetic volumes in ultrasound-guided interscalene brachial plexus block for shoulder arthroscopy: Prospective randomized study2024 · 2 citations
  4. 4Assessment of the Incidence of Diaphragmatic Paralysis by Ultrasound After Different Volumes of Supraclavicular Block2025
  5. 5The diaphragm-sparing effect of interscalene block with a low-volume of ropivacaine 0.1% vs. 0.5%2026 · 1 citations