Diaphragmatic Paralysis in Arthroscopic Shoulder Surgery

Study Overview
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Brief Summary
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This study aims to assess consequences and causes of hemidiaphragmatic paralysis for ambulatory arthroscopic shoulder surgery in patients with BMI ≥ 30 kg/m².

Detailed Description
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This prospective observational study will screen patients with body mass index (BMI) ≥30 kg/m² undergoing acromioplasty or supraspinatus tendon repair. Occurrence of post-operative hemidiaphragmatic paralysis will be observed using M-mode ultrasonography and its consequences on patient ventilation: arterial oxygen saturation, dyspnea, success of ambulatory procedure. Causes of diaphragmatic paralysis will be analyzed.

Official Title
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Diaphragmatic Paralysis in Arthroscopic Shoulder Surgery: Consequences and Causes

Conditions
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Dyspnea, Hypoxia, Analgesia

Intervention / Treatment
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* Procedure: diaphragmatic assessment using ultrasounds.


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients with body mass index ≥ 30kg/m², undergoing ambulatory arthroscopic shoulder surgery (acromioplasty and supraspinatus tendon repair) will be screened. Exclusion Criteria: age <18 years, brachial plexus neuropathies, severe bronchopulmonary disease, acute respiratory distress, coagulopathies, systemic glucocorticoid use, pregnancy, routine use of opioid medications, intolerance for one or more medications of the study protocol and diabetes.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| diaphragmatic paralysis/paresis group<br>Diaphragmatic paralysis can be associated with regional anesthesia procedure in arthroscopic shoulder surgery as phrenic nerve is close to the brachial plexus. Diaphragmatic paralysis will be defined using ultrasounds. | Procedure: diaphragmatic assessment using ultrasounds.<br>* A diaphragmatic assessment will be performed using ultrasound. This is a pain free assessment. This assessment is commun in our unit after arthroscopic shoulder surgery.<br>|
| No diaphragmatic paralysis/paresis group<br>Some strategies of peripheral nerve block are able to spare diaphragmatic paralysis. | Procedure: diaphragmatic assessment using ultrasounds.<br>* A diaphragmatic assessment will be performed using ultrasound. This is a pain free assessment. This assessment is commun in our unit after arthroscopic shoulder surgery.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Failure of outpatient arthroscopic shoulder surgery strategy | failure of outpatient arthroscopic shoulder surgery strategy is communly associated with dyspnea or hypoxia due to diaphragmatic paralysis | the first 6 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Assessment of peripheral nerve block strategy associated with diaphragmatic paralysis | Different strategies of peripheral nerve block can be proposed for post-operative pain relief in arthroscopic shoulder surgery. All strategies were grouped in 3 parts: Interscalene block with high volume of local anesthetics Interscalene block with low volume of local anesthetics distal block | the first 2 hours |