الفهرس 
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Abstract
IBPB offers adequate postoperative analgesia, a low incidence of nausea and vomiting, and low opioid requirements. However, it could also result in severe complications such as phrenic block. In 1991, Urmey et al. found that 100% of their IBPBs produced a phrenic blockade with acute ipsilateral hemi diaphragmatic paralysis (HDP), which decreased pulmonary function.
This was a randomized control trial including adult patients undergoing shoulder surgery at Suez Canal university hospitals. Protocol agreement was obtained from the Ethical Committee of Faculty of Medicine at Suez Canal University. In addition, all participants signed a consent form before enrolling to the study .
Patients were enrolled according to the inclusion criteria and then divided randomly into two groups. group A received 15ml of bupivacaine 0.5% in performance of ISBPB while group B were injected with 10 ml of bupivacaine 0.5%.
Diaphragmatic excursion was assessed by real-time US of theipsilateral hemidiaphragm at the cephalad border of the zone of apposition (Zap) of the diaphragm to the costal margin between the midclavicular and the anterior axillary lines.
General anesthesia was induced with intravenous (IV) propofol, 2 to 2.5mg/kg and rocuronium 0.6mg/kg. After endotracheal intubation, anesthesia was maintained with inhalational anesthesia with isoflurane. After induction of general anesthesia, the patient’s position was changed to lateral decubitus. BP, HR, temp and SpO2 were recorded during the operation.