• José Cros Campoy, Oscar Domingo Bosch, Jaume Pomés, Jing Lee, Ben Fox, and Xavier Sala-Blanch.
• Anesthesia, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK.
• Reg Anesth Pain Med. 2019 May 22.

Background And ObjectivesIpsilateral phrenic nerve palsy (PNP) is an undesirable side of conventional approaches to interscalene brachial plexus blocks. The purpose of this study was to demonstrate whether or not the phrenic nerve can be spared by dye when injected at the division of the upper trunk of the brachial plexus.MethodsUnder ultrasound guidance, 5 mL of radiolabeled dye was injected between the anterior and posterior division of the upper trunk in two fresh, cryopreserved cadavers. CT scan analysis, cadaveric dissection, and cryosectioning were performed to examine the spread of the injectate.ResultsWe found staining of the injectate over the entire upper trunk with its anterior and posterior divisions, the suprascapular nerve under the omohyoid muscle and the lateral pectoralis nerve, and the C5 and C6 roots. The middle trunk was partially stained. There was no evidence of dye staining of the lower trunk, anterior aspect of the anterior scalene muscle, or the phrenic nerve.ConclusionsOur study offers an anatomical basis for the possibility of providing shoulder analgesia and avoiding a PNP.© American Society of Regional Anesthesia & Pain Medicine 2019. No commercial re-use. See rights and permissions. Published by BMJ.

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