Does low-volume inter-scalene block attenuate the severity of diaphragmatic paresis?
K. J. Chin Toronto, Canada E-mail: gasgenie{at}gmail.com’ + u + ‘@’ + d + ”//–> Editor—I commend Riazi and colleagues1 on their important study demonstrating that the analgesic effect of an interscalene brachial plexus block (ISBPB) may be achieved with an extremely low volume (5 ml) of local anaesthetic, while simultaneously reducing the incidence of phrenic nerve palsy (from 100% to 45%). There were also significantly smaller reductions in mean spirometry values in the low-volume group. It is not clear however, if the low-volume technique achieved this by attenuating the severity of diaphragmatic paresis in patients who did develop phrenic nerve palsy (nine of 20), or whether this result was primarily because of normal or near-normal spirometry values in those patients who did not develop a palsy. It would be helpful if the authors reported the spirometric data separately in these two subgroups of patients who received the low-volume block. Without this information, the authors’ co
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