Monitoring phrenic nerve paresis with POCUS After Regional Anesthesia - NYSORA

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Monitoring phrenic nerve paresis with POCUS After Regional Anesthesia

May 16, 2024

A 52-year-old male patient with a history of chronic shoulder dislocations presented for elective arthroscopic shoulder surgery. Given his past medical history and the expected surgical pain, an interscalene block was planned to provide postoperative analgesia.

Given the proximity of the phrenic nerve to the interscalene space, diaphragmatic paralysis is obsolete and a common side-effect associated with this block. To assess the completeness of the diaphragm dysfunction, point-of-care ultrasound (POCUS) was used before the block and repeated postoperatively. The diaphragmatic excursion and thickening were observed through ultrasound imaging to ensure the patient’s safety and comfort, mitigating the risk of respiratory complications.

This is an ultrasound image with the transducer in the subcostal area that was used to assess the excursion. Excursions of 0.8 cm were measured during shallow breathing.

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