Comparison of the incidence of Hemidiaphragmatic paresis following ultrasound-guided superior trunk block and interscalene block for elective humerus surgeries- a randomised controlled study.

After obtaining approval from the institutional ethical committee and informed consent from all patients in a language understood by them, a total of 56 patients (28 in each group) of ASA I & II undergoing elective humerus surgery will be included in the study.Patients will be divided into two groups of 28 each by using a computer-generated method (Research Randomizer), namely Group S, Group I. Group S-will receive ultrasound-guidedSuperior Trunk block using ROPIVACAINE 0.75% 15ml.Group I: will receive ultrasound-guidedInterscalene block using ROPIVACAINE 0.75% 15ml.

Spirometry will be done in sitting position before giving the block and 15 mins after giving the block and after shifting patient to PACU to assess the PEFR.Diaphragm will be assessed pre-operatively using USG machine so as the know the original condition of diaphragm. All blocks will be placed under sterile conditions in the operating room with sedation (intravenous midazolam 1-2 mg) The Interscalene block will be performed using a linear ultrasound transducer and PNS.After identifying the cervical roots and interscalene muscles, a 22-gauge needle will be inserted, lateral to medial, with in-plane technique into the interscalene groove. The tip of the needle will be placed in between C5 and C6, and 15 ml of 0.75% Ropivcaine will bedeposited. For the superior trunk block, after identifying the cervical roots and scalene muscles, the probe will be moved distally until the suprascapular nerve branches off the superior trunk are seen. The targeted level of insertion for the injection will be immediately before the branching off point of the suprascapular nerve. A 22G needle will be inserted, lateral to medial, using in-plane technique. The tip of the needle will be placed posterior/inferior to the trunk, and 10 ml0.75% Ropivacaine will be injected. 5ml will be injected anteriorly. After 15 to 20 min of the nerve block, each patient will have a sensory and motor examination by the anaesthesiologist to ensure blockade of the C5 and C6 nerve roots. Each patient will be assessed for numbness in the hand/arm and weakness during shoulder abduction.

In the event of an inadequate or failed blockade, general anaesthesia or supplemental blockade will be done before surgical incision and the patient will be excluded from further analysis. Sensory and motor blockades were assessed every 5 mins for 30 mins. The onset time for a sensory block was defined as the time elapsed between the end of the block procedure and the moment when the pinprick test yielded a score of 2. Failure to reach a score of 2 within 30 min of interscalene block was considered to be block failure, and the patient will be excluded from the study. Diaphragmatic excursion will be assessed

1. 15 mins before the block

2. 15 mins after the time of completion of block

3. 30 mins after the shifting the patient to PACU

Duration of Analgesia and use of rescue analgesic will be assessed 8 hourly for next 24 hours using NRPS scale