A Diaphragm-Sparing Nerve Block for Arthroscopic Shoulder Surgery?

"* ICB: US probe will be placed just below clavicle inferior to site of needle entry. Following identification of axillary artery and cords, the needle will be advanced posterior to axillary artery. 20 cc of Ropivacaine 0.375% will then be deposited in a U-shaped distribution posterior and to each side of the axillary artery.~* SSNB will be performed by locating the brachial plexus and the departure of the suprascapular nerve from the superior trunk under the inferior belly of the omohyoid muscle by sliding the transducer distally and then injecting 5 mL of ropivacaine 0.375%.~* SCNB will be performed injecting 5 mL of ropivacaine 0.375% in the intermuscular plane between the sternocleidomastoid and scalene muscles using a lateral to medial in-plane technique."

"Diaphragmatic excursion will be assessed under ultrasound immediately before and after regional anesthesia.~This a pain free and safe procedure, that we usually perform in patients at risk of respiratory failure."