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Respiratory Impact of Analgesic Strategies for Shoulder Surgery
  1. Peter Verelst, MD, EDRA* and
  2. André van Zundert, MD, PhD, FRCA, EDRA, FANZCA
  1. *Department of Anesthesia, AZ Nikolaas, Sint-Niklaas, Belgium; and †Department of Anesthesiology, Catharina Hospital-Brabant Medical School, Eindhoven; and University Ghent, Ghent, Belgium & University Maastricht, Maastricht, the Netherlands.
  1. Address correspondence to: André van Zundert, MD, PhD, FRCA, EDRA, FANZCA, Department of Anesthesiology, ICU & Pain Therapy, Catharina Hospital–Brabant Medical School, Michelangelolaan 2, NL-5623EJ Eindhoven, the Netherlands (e-mail: zundert{at}


Abstract Shoulder surgery is associated with significant postoperative pain in many patients. The use of an interscalene nerve block offers good analgesia but is associated with a high incidence of an ipsilateral phrenic nerve block. Several strategies to avoid this adverse effect have been studied. Possible strategies are (1) using very low volumes of local anesthetics, (2) targeting the brachial plexus at a lower level in the neck, (3) applying a suprascapular nerve block, and (4) applying the combination of a suprascapular and an axillary nerve block. Using systemic analgesics is a less favorable strategy because this may result in less potent analgesia and may cause more adverse effects, including respiratory depression and nausea.

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  • Joseph M. Neal, MD served as editor-in-chief for this article.

    No financial sources were received to support this work.

    The authors declare no conflict of interest

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