الفهرس 
Ultrasound guidance in regional anesthesiaOnly 14 pages are availabe for public view
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Abstract
Shoulder surgery is one of the most common ambulatory orthopedic
procedures. Advances in arthroscopic techniques have resulted in decreased
recovery times and complication rates. However, postoperative analgesia is
a major challenge. Interscalene nerve block remains the most commonly
used peripheral nerve block for shoulder surgery. It has a significant
analgesic benefit postoperatively, thus allowing early discharge and
lowering opioid consumption. However, its benefits are opposed by high
rates of hemidiaphragmatic paralysis. This side effect prevents its use
among patients with significant pulmonary disease. So newer regional
anesthesia techniques should be available to provide adequate analgesia
and decrease the incidence of phrenic nerve palsy. The superior trunk block
is a refinement of the conventional interscalene block technique. The
superior trunk is formed by the fusion of C5and C6 nerve roots, and
therefore local anesthetic injection around the superior trunk should
produce similar analgesia of the shoulder because all the terminal nerves
innervating the shoulder arise distal to the superior trunk. Moreover, the
site of injection is further away from the phrenic nerve, and this should
theoretically reduce the risk of hemi diaphragmatic paralysis.
Aim of the study
The aim of the study was to detect the occurrence of diaphragmatic
movement affection in ultrasound guided selective superior trunk block and
interscalene block in shoulder arthroscopy.
Patients and methods
We investigated sixty-eight patients scheduled for arthroscopic shoulder surgery of both sex aged 18 to 80 years with American Society of Anesthesiologists (ASA) physical status I or II. Patients with pre-existing
neuropathy in the operated limb, ASA ≥ III, coagulation disorders, known
allergy to local anesthetics, local infection at the puncture site, chronic
obstructive pulmonary disease or respiratory failure,block failure,
pregnancy, breast-feeding, and BMI ≥ 35 kg/m2 were excluded. Patients
who refused or couldn’t cooperate were also excluded. They were
randomized by use of sealed envelopes into two groups: interscalene group
and selective superior trunk group with (34) patients in each.. In both
groups ultrasound guided ISB or STB was done followed by induction of
general anesthesia.