Surgical Treatment of Permanent Diaphragm Paralysis after Interscalene Nerve Block for Shoulder Surgery

In a groundbreaking case series published in Anesthesiology, Kaufman et al. present a novel surgical approach for treating permanent diaphragm paralysis resulting from interscalene nerve blocks. This technique offers hope for patients suffering from this rare but significant complication of regional anesthesia.

Methodology and Patient Cohort

The study included 14 patients who developed persistent diaphragm paralysis following interscalene blocks for shoulder surgery. All patients had unresolved paralysis at least 6 months post-procedure. The surgical treatment involved phrenic nerve exploration, decompression, and in some cases, nerve grafting.

Key Findings

With varied follow-up periods, the results show promising outcomes:

1. 12 of 14 patients experienced improvement in diaphragm function post-surgery
2. Intraoperative findings were consistent with compression neuropathy of the phrenic nerve in most cases
3. No intraoperative or peri-operative complications were reported
4. Patients reported improvements in respiratory function and quality of life

Implications for Clinical Practice

This surgical approach offers several potential advantages:

• Provides a treatment option for patients with permanent diaphragm paralysis after interscalene block
• Addresses the underlying pathophysiology of the injury
• This may lead to functional improvement in a condition previously thought to be irreversible

While larger studies are needed, these initial results suggest that surgical intervention could be beneficial for select patients with this challenging complication.

We encourage you to read the full study for a comprehensive review of the surgical technique and outcomes.

As we continue to advance our understanding of regional anesthesia complications, techniques like this offer new hope for patients with persistent diaphragm paralysis.