Duke University
This prospective observational study aims to evaluate the incidence of hemidiaphragmatic paralysis in patients receiving interscalene brachial plexus nerve block with prolonged neural blockade. English speaking American Society of Anesthesiologists (ASA) 1-3 patients ages 18-80 receiving prolonged interscalene nerve block will be randomized into 3 groups: first group receiving a perineural catheter infusing 0.2% ropivacaine; the second group receiving a single shot injection of 10mL liposomal bupivacaine (Exparel; n=20) plus 5 mL 0.5% bupivacaine and the third receiving 20mL liposomal bupivacaine plus 5mL bupivacaine (to be determined by the attending anesthesiologist).Primary outcome will be incidence of hemidiaphragmatic paralysis postoperative day 1 as measured by point of care (POCUS) ultrasound.
This prospective observational study aims to evaluate the incidence of hemidiaphragmatic paralysis in patients receiving interscalene brachial plexus nerve block with prolonged neural blockade. English speaking ASA 1-3 patients ages 18-80 receiving prolonged interscalene nerve block will be randomized into 3 groups first group receiving a perineural catheter infusing 0.2% ropivacaine; the second group receiving a single shot injection of 10mL liposomal bupivacaine (Exparel; n=20) plus 5 mL 0.5% bupivacaine and the third group receiving 20mL liposomal bupivacaine plus 5mL bupivacaine (to be det…
Inclusion Criteria: * English speaking 18-80 year old ASA 1-3 patients * Primary shoulder surgery * Must live within a 25 mile radius Exclusion Criteria: * ASA 4 or 5 * Revision shoulder surgery * Diagnosis of chronic pain * Daily chronic opioid use (over 3 months of continuous opioid use) * Inability to communicate pain scores or need for analgesia * Infection at the site of block placement * Age under 18 years old or greater than 80 years old * Pregnant women (as determined by point-of-care serum bHCG) * Intolerance/allergy to local anesthetics * Weight \<50 kg * BMI \> 40 * severe pulmon…
Ultrasound guided evaluation of diaphragm ipsilateral to the block side.
Local anesthetic (numbing drug)
Local anesthetic (numbing drug)
Non-invasive respiratory monitor to measure oxygenation and ventilation parameters
Arctuva estimate
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