ISB HEMDAPHRAGMATIC PARESIS
Interscalane block was performed under ultrasound guidance. Before and 30 min after the block, an independent observer evaluated ipsilateral hemidiaphragmatic movement on deep inspiration by ultrasonography using a 2-5 MHz broadband curved array transducer. Patients were examined in the semirecumbent position and scanned from a subcostal approach using the liver or spleen as an acoustic window. A < 25% reduction in Diaphragmatic Excursion (DE) was taken as mild paresis. Partial diaphragmatic palsy is diagnosed by a reduction in DE of 25-75% and complete palsy is confirmed by a more than 75% reduction in DE or paradoxical cephalad movement of the diaphragm.  The sensory blockade was assessed every five min for up to 30 min by the pinprick method in the C5-6 dermatome on a 3-point verbal rating scale: 0 - normal sensation, 1 - dull sensation (analgesia) and 2 - no sensation (anaesthesia). The onset time for a sensory block was defined as the time elapsed between the time of drug administration and the moment when the pinprick test yielded a score of two. Failure to reach a score of two within 30 min of interscalene block was considered to be block failure. General anaesthesia was administered to these patients. But results from these patients were also included in the final analysis based on intention to treat rather than per-protocol basis. [12, 13] The total cases of block failure were noted and the success rate for different groups was compared. The total duration of surgery was documented. At the end of the surgery, the patient was shifted to the postoperative ward. The Visual Analogue Scale (VAS) was used to assess pain and the patient was explained about the score. The patient was administered paracetamol 1g intravenously (IV) when VAS ≥ 4 and repeated after six hours only when VAS ≥ 4. If the patient has pain even after paracetamol administration, tramadol 100 mg IV was used as a rescue analgesic. The duration of postoperative analgesia was defined as the time taken from the administration of the block to the time of the first request for postoperative analgesia (VAS ≥ 4).  The patients were observed for any other side effects like hoarseness of voice, and Horners’ syndrome. The patients were followed up for 24 hours.