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Background and Aims A 50 years old, male patient, was scheduled for surgical repair of rotator cuff injury. An interscalene approach to the brachial plexus was selected to provide analgesia and was combined with general anesthesia (TIVA). During the immediate post-operative period, the patient developed shortness of breath and complained for easy fatigue, which, after a detailed examination, were attributed to a paralysis of the right phrenic nerve, resulting in the elevation of the right hemidiaphragm and causing the symptoms. This was considered a complication of the interscalene block.

Methods After six months with no improvement, a restoration of the diaphragm with thoracoscopic technique was decided. The patient was scheduled for diaphragm plication. The anesthesia was performed with paravertebral block and general anesthesia (TIVA). Throughout the 6 hours long surgery, the patient remained hemodynamically stable, while he didn’t present any other analgesic demands. After the operation, the patient was extubated and his level of analgesia was assessed, based on NOL (15) and VAS (2) scales.

Results Throughout the 6 hours long surgery, the patient remained hemodynamically stable, while he didn’t present any other analgesic demands. After the operation, the patient was extubated and his level of analgesia was assessed, based on NOL (15) and VAS (2) scales.

Conclusions Paravertebral block is an attractive regional anesthetic technique, as it can provide excellent unilateral analgesia, with a low rate of hypotension compared to epidural anesthesia for thoracic and abdominal procedures. In our case, paravertebral block was proved an efficient analgesic technique for a long and laborious time operation.