{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T08:10:40Z","timestamp":1778659840595,"version":"3.51.4"},"reference-count":0,"publisher":"The Korean Society of Anesthesiologists","content-domain":{"domain":["anesth-pain-med.org"],"crossmark-restriction":true},"short-container-title":["Anesth Pain Med"],"abstract":"<jats:p>Background: Interscalene block (ISB) is widely used for upper limb surgery but frequently causes hemidiaphragmatic paralysis (HDP). Superior trunk block (STB) has emerged as a promising alternative that preserves phrenic nerve. This study aimed to evaluate whether STB is a safer option than ISB.Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered in PROSPERO (CRD420250654685). Randomized controlled trials (RCTs) comparing STB and ISB in adults undergoing upper limb surgery and reporting HDP as the primary outcome were included. Secondary outcomes were postoperative pain, opioid consumption, motor block duration, patient satisfaction, and Horner\u2019s syndrome. Comprehensive searches were conducted through June 2025 in PubMed, Scopus, Embase, Cochrane, and Web of Science. Data were analyzed using a random-effects model in R, and trial sequential analysis was applied to assess statistical robustness.Results: Eight RCTs involving 597 patients were included. Compared with ISB, STB significantly reduced the incidence of complete HDP (risk ratio [RR], 0.10; 95% confidence interval [CI], 0.07\u20130.17; I2  = 0%, P  &lt; 0.001) and Horner\u2019s syndrome (RR, 0.06; 95% CI, 0.01\u20130.24; I2  = 0%, P  &lt; 0.001). No significant differences were observed in opioid consumption (P  = 0.262), pain scores (P  = 0.661), patient satisfaction on a 0\u201310 scale (P  = 0.117), or motor block duration (P  = 0.624).Conclusions: STB provides postoperative analgesia comparable to ISB while significantly reducing the incidence of HDP and Horner\u2019s syndrome, supporting its role as a safer and effective alternative for shoulder surgery.<\/jats:p>","DOI":"10.17085\/apm.25415","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:34:45Z","timestamp":1778657685000},"update-policy":"https:\/\/doi.org\/10.17085\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence of hemidiaphragmatic paralysis in superior trunk versus interscalene block upper limb surgeries: a systematic review, meta-analysis, and trial sequential analysis"],"prefix":"10.17085","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-9305-3967","authenticated-orcid":true,"given":"Diogo Fonseca","family":"da Cunha","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Surgery, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1108-1870","authenticated-orcid":true,"given":"Jo\u00e3o Paulo Aureliano","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2713-5941","authenticated-orcid":true,"given":"Beatriz","family":"de Olinda Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9716-7839","authenticated-orcid":true,"given":"Elias Batista","family":"da Silva Neto","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9466-6537","authenticated-orcid":true,"given":"Liana Maria T\u00f4rres","family":"de Ara\u00fajo Azi","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Federal University of Bahia, Salvador, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8549-6820","authenticated-orcid":true,"given":"Norma Sueli Pinheiro","family":"M\u00f3dolo","sequence":"additional","affiliation":[{"name":"Department of Surgical Specialties and Anaesthesiology, School of Medicine, S\u00e3o Paulo State University, Botucatu, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8009-3726","authenticated-orcid":true,"given":"Rodrigo Leal","family":"Alves","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Surgery, Federal University of Bahia, Salvador, Brazil"},{"name":"Department of Surgical Specialties and Anaesthesiology, School of Medicine, S\u00e3o Paulo State University, Botucatu, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2573","published-online":{"date-parts":[[2026,5,13]]},"container-title":["Anesthesia and Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/anesth-pain-med.org\/upload\/pdf\/apm-25415.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T07:34:46Z","timestamp":1778657686000},"score":1,"resource":{"primary":{"URL":"http:\/\/anesth-pain-med.org\/journal\/view.php?doi=10.17085\/apm.25415"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":0,"URL":"https:\/\/doi.org\/10.17085\/apm.25415","relation":{},"ISSN":["1975-5171","2383-7977"],"issn-type":[{"value":"1975-5171","type":"print"},{"value":"2383-7977","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"2025-10-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-13","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}}]}}