• Marcos Guilherme Cunha Cruvinel, Carlos Henrique Viana de Castro, Yerkes Pereira Silva, Roberto Cardoso Bessa Júnior, Flávio de Oliveira França, and Flávio Lago.
• Hospital Lifecenter.
• Rev Bras Anestesiol. 2006 Oct 1;56(5):461-9.

Background And ObjectivesBrachial plexus blockade by the interscalene approach, described by Winnie, is one of the most effective techniques in promoting postoperative analgesia in surgeries of the shoulder. Diaphragmatic paralysis is one of the consequences of this technique. This paralysis can cause respiratory failure in patients with prior lung dysfunction. Brachial plexus blockade by the posterior approach has become increasingly more popular. The objective of this study was to determine the prevalence of diaphragmatic paralysis after interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine.MethodsTwenty-two patients who underwent interscalene brachial plexus blockade by the posterior approach with 0.2% ropivacaine were evaluated in the postoperative period to identify radiological signs of elevation of the hemidiaphragm that could suggest hemidiaphragmatic paralysis. Forty mL of 0.2% ropivacaine were used in 20 patients; inspiratory chest X-rays were done in these patients. Twenty mL of 0.2% ropivacaine were used in two patients, with posterior fluoroscopic evaluation.ResultsThere were no complications related to the procedure. The anesthesia was effective in every patient, providing good postoperative analgesia. Every patient in this study presented elevation of the diaphragm compatible with hemidiaphragmatic paralysis.ConclusionsWe observed that brachial plexus blockade by the posterior approach is associated with a high prevalence of diaphragmatic paralysis, even with low concentrations of local anesthetics.

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