Diaphragmatic Effects of Combined Infraclavicular Brachial Plexus Block and Suprascapular Nerve Block (ICB-SNB)

Evaluation of the Effects of Combined Infraclavicular Brachial Plexus Block and Suprascapular Nerve Block on the Diaphragm in Arthroscopic Shoulder Surgery

This prospective observational study was conducted to evaluate the effects of a combined infraclavicular brachial plexus block and anterior suprascapular nerve block on diaphragmatic function in patients undergoing arthroscopic shoulder surgery. A total of 61 adult patients were enrolled in the study. Diaphragmatic excursion was assessed using ultrasonography both prior to block administration and 30 minutes following the procedure during normal and deep breathing. The primary objective was to assess changes in diaphragmatic excursion and determine the incidence of hemidiaphragmatic paralysis associated with this combined block technique. Secondary outcomes included block performance time, duration of postoperative analgesia, the need for additional intraoperative sedation or analgesia, the occurrence of adverse events, and levels of patient and surgeon satisfaction. The study sought to determine whether this regional anesthesia approach could provide effective anesthesia and analgesia while minimizing impairment of diaphragmatic function.

Study Overview

• Status: Completed
• Conditions: Arthroscopic Shoulder Surgery; Diaphragmatic Excursion; Hemidiaphragmatic Paralysis

Detailed Description

This prospective observational study was conducted to evaluate the effects of combined infraclavicular brachial plexus block and anterior suprascapular nerve block on diaphragmatic excursion in patients undergoing elective arthroscopic shoulder surgery.

Patients scheduled for arthroscopic shoulder surgery under regional anesthesia were enrolled in the study. Prior to block administration, baseline diaphragmatic excursion was assessed using ultrasonography during both normal and deep breathing. Each measurement was repeated three times, and the mean value was recorded. The same measurements were repeated 30 minutes after completion of the block procedures using an identical protocol.

The percentage change in diaphragmatic excursion between baseline and post-block measurements was calculated for both normal and deep breathing. Hemidiaphragmatic paralysis was categorized according to the degree of reduction in diaphragmatic excursion as absent (≤25% reduction), partial (25.1-74.9% reduction), or complete (≥75% reduction).

All nerve blocks were performed under ultrasound guidance by anesthesiologists experienced in regional anesthesia techniques. The infraclavicular brachial plexus block was performed using 15 mL of 0.5% bupivacaine deposited around the posterior cord and 8 mL of 0.5% bupivacaine around the lateral cord. The anterior suprascapular nerve block was performed with 7 mL of 0.5% bupivacaine. In addition, arthroscopic portal sites were infiltrated with 10 mL of 0.2% bupivacaine to provide supplementary analgesia.

All patients received intravenous midazolam (2 mg) and paracetamol (1 g) during the intraoperative period. Additional analgesic or sedative medication was administered when required according to clinical conditions and surgical needs. Block performance time, requirement for supplemental analgesia or sedation, and any block-related adverse events were recorded.

The primary outcome measure was the change in diaphragmatic excursion measured by ultrasonography 30 minutes after block administration. Secondary outcome measures included the incidence and severity of hemidiaphragmatic paralysis, block performance time, duration of postoperative analgesia, need for additional intraoperative analgesia or sedation, time to first analgesic requirement, patient and surgeon satisfaction, block-related complications, and conversion to general anesthesia.

The study was designed to investigate whether the combination of infraclavicular brachial plexus block and anterior suprascapular nerve block could provide effective anesthesia and analgesia for arthroscopic shoulder surgery while minimizing impairment of diaphragmatic function and reducing the incidence of clinically significant hemidiaphragmatic paralysis.

• Study Type: Observational
• Enrollment (Actual): 61

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Ankara
    • Ankara, Ankara, Turkey (Türkiye), 06500
      • Gazi University Faculty of Medicine Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients aged 18-80 years with ASA physical status I-III undergoing elective arthroscopic shoulder surgery at Gazi University Faculty of Medicine Hospital. Eligible participants received ultrasound-guided combined infraclavicular brachial plexus block and anterior suprascapular nerve block. The study evaluated changes in diaphragmatic excursion measured by ultrasonography before and after block administration.

Description

Inclusion Criteria:

• Patients aged 18-80 years.
• ASA physical status I-III.
• Scheduled for elective arthroscopic shoulder surgery.
• Ability to provide written informed consent

Exclusion Criteria:

• Refusal to undergo peripheral nerve block.
• Pre-existing peripheral neuropathy.
• Known pulmonary, hepatic, or renal disease.
• Allergy to local anesthetics.
• Infection at the block site.
• Pre-existing neurological deficit.
• Body mass index (BMI) > 40 kg/m².
• Coagulopathy.
• Sepsis.

• Previous surgery at the planned block site.

  • Major psychiatric disorders.
  • Inability to complete diaphragmatic ultrasonographic assessment.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
Patients Undergoing Arthroscopic Shoulder Surgery; Patients undergoing arthroscopic shoulder surgery who received a combined infraclavicular brachial plexus block and anterior suprascapular nerve block. Diaphragmatic excursion was evaluated using ultrasonography before and after block administration.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Diaphragmatic Excursion at 30 Minutes After Block Administration	Diaphragmatic excursion measured by ultrasonography during normal and deep breathing before block administration and 30 minutes after block administration. The percentage change from baseline was calculated.	30 minutes after block administration

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Hemidiaphragmatic Paralysis	Presence of hemidiaphragmatic paralysis determined by ultrasonographic assessment of diaphragmatic excursion.	30 minutes after block administration
Degree of Hemidiaphragmatic Paralysis	Hemidiaphragmatic paralysis classified as absent (≤25% reduction), partial (25.1-74.9% reduction), or complete (≥75% reduction)	30 minutes after block administration
Block Performance Time	Time required to complete the combined infraclavicular brachial plexus block and anterior suprascapular nerve block.	From needle insertion to completion of the block procedure
Additional Intraoperative Analgesia Requirement	Requirement for supplemental analgesic medication during surgery.	From surgical incision to the end of surgery
Time to First Analgesic Requirement	Time from completion of the block procedure to the first postoperative analgesic request.	Up to 24 hours after surgery
Block-Related Complications	Incidence of block-related adverse events including Horner syndrome, hoarseness, nausea/vomiting, and hemodynamic complications.	From block administration until 24 hours after surgery

Collaborators and Investigators

• Sponsor: Gazi University
• Investigators: Principal Investigator: IRFAN GUNGOR, MD, Gazi University Faculty of Medicine

Study record dates

Study Major Dates

• Study Start (Actual): February 22, 2025
• Primary Completion (Actual): July 20, 2025
• Study Completion (Actual): July 20, 2025

Study Registration Dates

• First Submitted: May 31, 2026
• First Submitted That Met QC Criteria: June 5, 2026
• First Posted (Actual): June 10, 2026

Study Record Updates

• Last Update Posted (Actual): June 10, 2026
• Last Update Submitted That Met QC Criteria: June 5, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Regional Anesthesia; Diaphragmatic Excursion; Shoulder Arthroscopy; Anterior Suprascapular Nerve Block; Infraclavicular Brachial Plexus Block
• Other Study ID Numbers: 2024-GUTF-028

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data collected during the study will not be shared with other researchers because of institutional policies, ethical considerations, and protection of participant confidentiality.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No