الفهرس 
Anatomy
Intrafascial (conventional) ISBPBOnly 14 pages are availabe for public view
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Abstract
ISBPB is a central component of perioperative analgesia for major shoulder surgery as many patients experience moderate to severe postoperative pain without such blocks. It anesthetizes the superior (C5, C6) and middle (C7) trunks of the brachial plexus. However, the block may be associated with some complications, the most common is phrenic nerve palsy, which occurs in 100% of patients when using high volume of local anesthesia. The aim of this study was to compare the efficacy and safety of extrafascial versus intrafascial injection of bupivacaine for ISBPB in patients undergoing shoulder arthroscopy. These effects are in terms of diaphragmatic excursion reduction as an indicator of phrenic nerve palsy, the efficacy of block (sensory and motor), measurement of pulmonary function tests, assessment of pain intensity using NRS, as well as measurement of the total postoperative analgesic consumption. The study was carried out on 50 adult patients who were randomly allocated into two equal groups. Patients in group I (intrafascial injection group) received 10 ml of 0.5% bupivacaine for intrafascial ISBPB, whereas those in group E (extrafascial injection group) received the same volume and concentration of bupivacaine for extrafascial ISBPB. Our results reveled that extrafascial injection of bupivacaine in group E has less effect on diaphragmatic excursion either 30 min after the block, or at PACU compared to intrafascial injection of bupivacaine in group I. Following the block, no patient in both groups had complete hemidiaphragmatic paralysis (i.e., >75% reduction in diaphragmatic excursion from baseline). On the other hand, the partial hemidiaphragmatic paralysis (i.e., 25-75% reduction) was observed in 12% of patients in group I but none in group E thirty minutes after the block. This incidence was increased to 56% of group I patients and 12% of group E patients at PACU. The spirometric parameters (FVC, FEV1 and PEF) in both groups were comparable before block and after discharge from PACU. The onset of sensory and motor blocks was delayed in group E compared to group I. The time to first analgesic request as well as NRS were similar in both groups at all time measurements. Total morphine consumption in the 1st 24 hours was comparable between both groups.