Hemidiaphragmatic paralysis after ultrasound-guided brachial plexus blocks for shoulder surgery: A systematic review and meta-analysis of randomized clinical trials
Authors' conclusion
There is conclusive evidence that the extrafascial technique (high-level); lower concentration technique (moderate-level); and the supraclavicular blockade (low-level) are less detrimental to hemidiaphragmatic paralysis than the conventional ISB. However, the results for other comparisons were not definitive.
Study context
- Population
- Adults undergoing shoulder surgery with ultrasound-guided brachial plexus blockade, incidence of hemidiaphragmatic paralysis reported
- Participants
- 1,737 adults · 28 RCTs
- Comparison
- Diaphragm-sparing regional techniques vs conventional interscalene brachial plexus block (ISB)
- Outcome
- Incidence of complete hemidiaphragmatic paralysis
Methodological detailsmeta-regression, trial sequential analysis, GRADE methodology, 22 RCTs eligible for meta-analysis; six regional techniques analysed
- Meta-regression
- Trial sequential analysis
- GRADE methodology
- 22 RCTs eligible for meta-analysis; six regional techniques analysed
Pooled result
As reported in the abstract
Hemidiaphragmatic paralysis · short-term follow-up
Low-volume ISB vs Conventional ISBRelative risk (95 % CI)P value
I2 = 80 %
0.62(0.42–0.91)
P = 0.02Low-volume ISB vs Conventional ISBAbsolute risk difference (95 % CI)
Hemidiaphragmatic paralysis
- 0.30(−0.39 to −0.20)
%
- Infraclavicular-suprascapular blocks reduced incidence vs conventional ISB
- 97
- Extrafascial ISB reduced incidence vs conventional ISB
- 64
- Lower concentration ISB reduced incidence vs conventional ISB
- 57
- Supraclavicular block reduced incidence vs conventional ISB
- 46
Original publication
Hemidiaphragmatic paralysis after ultrasound-guided brachial plexus blocks for shoulder surgery: A systematic review and meta-analysis of randomized clinical trials. J Clin Anesth. Published 9 June 2025. doi:10.
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