Abstract
Background: Temporary diaphragmatic paralysis following interscalene brachial plexus block is a common complication that may exacerbate adverse respiratory events in patients with underlying pulmonary conditions. Objective: To compare the incidence of diaphragmatic paralysis between two concentrations of levobupivacaine (0.375% and 0.5%) administered at the same dose of 2 mg/kg, and to analyze risk factors associated with intraoperative SpO₂ reduction. Materials and methods: Randomized clinical trial was conducted on 80 patients undergoing clavicle and upper limb surgery. Diaphragmatic excursion and velocity were measured via ultrasound before and 20 minutes after the block. Results: Patients who successfully underwent ultrasound-guided interscalene brachial plexus block for surgery had a 100% incidence of diaphragmatic paralysis. The group receiving 0.375% levobupivacaine with a volume of 29.3 mL exhibited a significantly higher incidence and severity of diaphragmatic paralysis compared to the 0.5% group with a volume of 23.0 mL (77.5% vs. 27.5%, p < 0.05). Complete paralysis, age ≥ 60 years, and BMI ≥ 25 were identified as risk factors for intraoperative SpO₂ reduction. Conclusion: Low volume and high concentration of local anesthetic can lower both the incidence and severity of diaphragmatic paralysis and the risk of intraoperative oxygen desaturation.
| Published | 2026-09-28 | |
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| Issue | Vol. 16 No. 5 (2026) | |
| Section | Original Articles | |
| DOI | 10.34071/jmp.2026.5.991 | |
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