Diaphragmatic Paralysis After Interscalene Nerve Block: Just Saline or a Saviour! A Hamlet Situation.

Abstract

Introduction: The Interscalene nerve block has been performed as a primary technique for upper humerus surgeries for quite some time. The hemidiaphragmatic paralysis that accompanies the block can be distressing, placing the anaesthesiologist in a problematic situation. The minimum reported incidence of hemidiaphragmatic paralysis following this block is 20%, even with ultrasound-guided, very low volume and concentration of the drug. This has led to several modifications of the original technique and drug in terms of dosage, volume, and concentration. However, the incidence remains significant and is large enough to be overlooked. A method that can reverse hemidiaphragmatic paralysis while preserving the desired block effects can prove to be a valuable asset to the anesthesiologist. Here, we report a case of successful reversal of hemidiaphragmatic paralysis caused by phrenic nerve involvement resulting from an interscalene block. Normal saline was injected in the same area where the interscalene block was performed in the patient scheduled for midshaft humerus fracture