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Diaphragm-sparing nerve blocks for shoulder surgery: essentials of our current understanding
De Q Tran1, Samita Pirotesak2,3, Daniela Bravo4
1Anesthesia, McGill University, Montreal, Quebec, Canada maysanaatran@gmail.com.
Regional Anesthesia and Pain Medicine
|July 24, 2026
Summary
Shoulder surgery in patients with lung disease presents challenges. This review covers diaphragm-sparing nerve blocks as alternatives to interscalene brachial plexus block, highlighting current knowledge and future research needs.
Area of Science:
- Anesthesiology and Thoracic Surgery
Background:
- Shoulder surgery poses risks for patients with pulmonary disease.
- Interscalene brachial plexus block can cause diaphragm paralysis.
Purpose of the Study:
- To review diaphragm-sparing nerve block alternatives for shoulder surgery.
- To discuss shoulder innervation, hemidiaphragmatic paralysis, and evidence for nerve blocks.
Main Methods:
- Literature review of randomized trials on diaphragm-sparing nerve blocks.
- Analysis of evidence supporting various nerve block strategies.
Main Results:
- Multiple diaphragm-sparing alternatives to interscalene brachial plexus block have been studied.
- Evidence supports various diaphragm-sparing nerve block strategies.
Conclusions:
- Diaphragm-sparing nerve blocks are crucial for managing shoulder surgery in pulmonary patients.
- Further research is needed to address knowledge gaps in diaphragm-sparing strategies.
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