Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery

Anatomical, Physiologic, and Clinical Considerations

Kariem El-Boghdadly, F.R.C.A.; Ki Jinn Chin, F.R.C.P.C.; Vincent W. S. Chan, F.R.C.P.C.


Anesthesiology. 2017;127(1):173-191. 

In This Article

Materials and Methods

For this narrative review, we systematically searched electronic databases including MEDLINE, PubMed-not-MEDLINE, Excerpta Medica database (Embase), Cochrane Central Controlled Trials Database Register, and Cumulative Index to Nursing and Allied Health Literature (CINAHL), supplemented by a manual search. Search terms in medical subject headings, text words, and controlled vocabulary terms were used in permutations relevant to the components of this review. Search terms included (1) regional anesthesia; (2) local anesthesia; (3) shoulder; (4) surgery; (5) phrenic; (6) nerve; (7) diaphragm; and (8) diaphragmatic. Filters applied included (1) publication date January 1, 1946, to November 1, 2016; (2) English language; (3) human studies; and (4) adult studies. Eligible trials included randomized or quasirandomized controlled trials, controlled trials, case series, or pertinent correspondence that were deemed relevant or providing new knowledge on the subject in question. Trials were excluded if they produced no original empirical data, or if they were not directly relevant to phrenic nerve palsy related to regional anesthesia for shoulder surgery (fig. 1).

Figure 1.

Flowchart of study selection. CINAHL = Cumulative Index to Nursing and Allied Health Literature.

Studies were supplemented qualitatively with an informal literature search for relevant articles describing anatomical, physiologic, clinical, and diagnostic concepts so as to provide a comprehensive insight into the subject.