• Yumin Jo, Chahyun Oh, Woo-Yong Lee, Donggeun Lee, Suyeon Shin, Woosuk Chung, Chaeseong Lim, Sun Yeul Lee, and Boohwi Hong.
• From the Department of Anaesthesiology and Pain Medicine (YJ, CO, DL, SS, WC, CL, SYL, BH) and Department of Orthopaedic Surgery, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, South Korea (W-YL).
• Eur J Anaesthesiol. 2024 Oct 1; 41 (10): 760768760-768.

BackgroundInter-scalene block (ISB) is associated with an inevitable risk of hemi-diaphragmatic paresis (HDP). To reduce the risk of HDP, an upper trunk block (UTB) has been proposed at the brachial plexus division level.ObjectiveWe hypothesised that UTB would be associated with a lower incidence of HDP than ISB while providing sufficient analgesia following arthroscopic shoulder surgery.DesignRandomised controlled trial.SettingA tertiary teaching hospital.PatientsSeventy patients aged 20 to 80 years undergoing arthroscopic rotator cuff repair.InterventionUltrasound-guided ISB or UTB was performed with 5 ml 0.75% ropivacaine.Main Outcome MeasuresThe primary outcome was the incidence of complete HDP, assessed by diaphragm excursion using ultrasound, defined as a decrease to 25% or less of baseline or occurrence of paradoxical movement. Postoperative pulmonary function change, pain scores, opioid consumption and pain-related outcomes were the secondary outcomes.ResultsThe UTB group had a significantly lower incidence of complete HDP than the ISB group [5.9% (2/34) vs. 41.7% (15/36); absolute difference, 35.8%; 95% confidence interval (CI), 17.8 to 53.7%; P  < 0.001]. The postblockade decline in pulmonary function was more pronounced in the ISB group than that in the UTB group. The pain score at 1 h postoperatively was not significantly different between the groups (ISB vs. UTB group: median 0 vs. 1; median difference, -1; 95% CI, -2 to 0.5). No significant difference was observed in any other secondary outcomes.ConclusionUTB was associated with a lower incidence of HDP compared with ISB while providing excellent analgesia in arthroscopic shoulder surgery.Trial RegistrationClinical Trial Registry of Korea ( https://cris.nih.go.kr ) identifier: KCT0007002.Irb NumberChungnam National University Hospital Institutional Review Board No. 2021-12-069.Copyright © 2024 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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