Introduction:

Shoulder surgery is associated with severe postoperative pain and interscalene brachial plexus block is the anesthetic technique of choice. However, this procedure is not without risks, such as the development of hemidiaphragmatic paralysis, limiting its usefulness in patients with a high probability of respiratory complications.

Objectives:

To analyze the different prevention strategies for hemidiaphragmatic paralysis in interscalene brachial plexus block, as well as to describe the principles that govern it, in the context of regional anesthesia for shoulder surgery.

Material and methods:

Bibliography was searched using medical databases (CONRICyT, PubMed, Medline, OVID, Cochrane), introducing key words: shoulder surgery, regional anesthesia, interscalene block, supraclavicular block, phrenic nerve, hemidiaphragmatic paralysis, complications and prevention.

Discussion and conclusions:

Interscalene block is valuable for providing anesthesia and analgesia in shoulder surgery, however, its benefits must be weighed against the risks. A reduction in phrenic nerve paralysis has been shown: using ultrasound guidance, reducing the volume and concentration of the local anesthetic, modifying the injection site and using a completely different regional anesthetic technique. It is imperative to incorporate this new knowledge to make this technique a safe and effective practice.

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