Ultrasound-Guided Selective Trunk Block Combined With Supraclavicular Nerve Block for Awake Shoulder Arthroscopy: A...

The evolution of shoulder arthroscopy from inpatient to outpatient settings has necessitated the development of advanced regional anesthesia techniques that provide reliable intraoperative analgesia and hemodynamic stability while minimizing respiratory complications associated with conventional interscalene brachial plexus blocks, which are often linked to unintended phrenic nerve blockade and resultant diaphragmatic dysfunction. This prospective case series (level of evidence IV) aimed to evaluate the surgical efficacy, patient tolerance, and preservation of phrenic nerve function using a hybrid regional anesthesia approach combining ultrasound-guided selective trunk block (SeTB) and supraclavicular nerve (SCN) block. Twenty-eight ASA I-II patients undergoing elective arthroscopic shoulder surgery received SeTB combined with SCN block using 23 mL of 0.5% bupivacaine. The technique achieved a 100% surgical success rate, with a mean operative duration of 1.88 ± 0.58 hours and a mean reduction in diaphragmatic excursion of 20.8 ± 1.7%. Overall, SeTB-SCN provided effective phrenic-sparing anesthesia for awake shoulder arthroscopy.