{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:25:46Z","timestamp":1793312746773,"version":"4.5.0"},"reference-count":43,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T00:00:00Z","timestamp":1752019200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Hemidiaphragmatic paralysis (HDP) may impair the pulmonary function, which could be a substantial issue in individuals suffering from underlying lung disease or compromised lung function. Hence, several diaphragm-sparing methods have been used to avoid HDP after brachial plexus blocks. Although various studies have reported a lower incidence of HDP with costoclavicular block (CCB) compared to supraclavicular block (SCB), a systematic review and meta-analysis to confirm the potential benefits has not been done. Therefore, we analyzed the association of HDP with CCB and SCB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>The incidence of HDP was the primary outcome, and the change in diaphragmatic thickness fraction (DTF), change in hemidiaphragm excursion, and change in peak expiratory flow rate (PEFR) were the secondary outcomes. Six full texts of the articles were selected in the systematic review and meta-analysis of 263 patients who received CCB and 269 patients who received SCB.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The incidence of HDP after CCB was significantly lower than that associated with SCB (16 vs. 115), risk difference: -0.41 (95% confidence interval [CI]: -0.48 to -0.34;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) without heterogeneity (I\n                      <jats:sup>2<\/jats:sup>\n                      = 0%). Contractility was more preserved in CCB, and hence, thickness of the diaphragm was more during inspiration. The mean difference in DTF% between the two groups was 33.58 (95% CI: 20.68\u201346.48). PEFR was more preserved in CCB when compared to SCB: standardized mean difference: 0.46 (95% CI: -0.20\u20130.72;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.24,\n                      <jats:italic toggle=\"yes\">I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      = 29%; fixed effect model).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The incidence of HDP after CCB was significantly lesser than that after SCB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/joacp.joacp_415_24","type":"journal-article","created":{"date-parts":[[2025,7,9]],"date-time":"2025-07-09T12:00:34Z","timestamp":1752062434000},"page":"587-599","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Hemidiaphragmatic paralysis following costoclavicular versus supraclavicular brachial plexus block: A systematic review and meta-analysis"],"prefix":"10.4103","volume":"41","author":[{"given":"Naaz","family":"Shagufta","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, AIIMS Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahay","family":"Nishant","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, AIIMS Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumar","family":"Rajnish","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, AIIMS Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asghar","family":"Adil","sequence":"additional","affiliation":[{"name":"Department of Anatomy, AIIMS Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,7,9]]},"reference":[{"key":"R1-20251001","first-page":"720","article-title":"Reduced hemidiaphragmatic paresis with a \u201ccorner pocket\u201d technique for supraclavicular brachial plexus block: Single-center, observer-blinded, randomized controlled trial","volume":"43","author":"Kang","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"R2-20251001","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1046\/j.1365-2044.2001.01708-2.x","article-title":"Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function","volume":"56","author":"Mak","year":"2001","journal-title":"Anaesthesia"},{"key":"R3-20251001","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1093\/bja\/aen229","article-title":"Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block","volume":"101","author":"Riazi","year":"2008","journal-title":"Br J Anaesth"},{"key":"R4-20251001","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/AAP.0b013e3182030648","article-title":"Decreasing the local anesthetic volume from 20 to 10 mL for ultrasound-guided interscalene block at the cricoid level does not reduce the incidence of hemidiaphragmatic paresis","volume":"36","author":"Sinha","year":"2011","journal-title":"Reg Anesth Pain Med"},{"key":"R5-20251001","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1093\/bja\/aev550","article-title":"Comparison of tissue distribution, phrenic nerve involvement, and epidural spread in standard- vs low-volume ultrasound-guided interscalene plexus block using contrast magnetic resonance imaging: a randomized, controlled trial","volume":"116","author":"Stundner","year":"2016","journal-title":"Br J 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after supraclavicular block in an obese man","volume":"32","author":"Erickson","year":"2009","journal-title":"Orthopedics"},{"key":"R10-20251001","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/S0952-8180(02)00387-2","article-title":"Severe respiratory failure after infraclavicular block with 0.75% ropivacaine: A case report","volume":"14","author":"Gentili","year":"2002","journal-title":"J Clin Anesth"},{"key":"R11-20251001","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/AAP.0b013e3181bfbd83","article-title":"Hemidiaphragmatic paresis can be avoided in ultrasound- guided supraclavicular brachial plexus block","volume":"34","author":"Renes","year":"2009","journal-title":"Reg Anesth Pain Med"},{"key":"R12-20251001","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1213\/00000539-199203000-00006","article-title":"Hemidiaphragmatic paresis during interscalene brachial plexus block: Effects on pulmonary function and chest wall 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brachial plexus block: A randomized, controlled, double-blind trial","volume":"118","author":"Albrecht","year":"2017","journal-title":"Br J Anaesth"},{"key":"R16-20251001","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1097\/AAP.0000000000000529","article-title":"Diaphragm-sparing nerve blocks for shoulder surgery","volume":"42","author":"Tran","year":"2017","journal-title":"Reg Anesth Pain Med"},{"key":"R17-20251001","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/00115550-200403000-00008","article-title":"Diaphragmatic excursion and respiratory function after the modified Raj technique of the infraclavicular plexus block","volume":"29","author":"Dullenkopf","year":"2004","journal-title":"Reg Anesth Pain Med"},{"key":"R18-20251001","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/00115550-200301000-00007","article-title":"Restricted infraclavicular distribution of the local anesthetic solution after infraclavicular brachial plexus block","volume":"28","author":"Rodri\u0301guez","year":"2003","journal-title":"Reg Anesth Pain Med"},{"key":"R19-20251001","first-page":"545","article-title":"An ultrasound study of the phrenic nerve in the posterior cervical triangle: implications for the interscalene brachial plexus block","volume":"33","author":"Kessler","year":"2008","journal-title":"Reg Anesth Pain Med"},{"key":"R20-20251001","first-page":"825","article-title":"Ultrasound-guided infraclavicular brachial plexus block: Prospective randomized comparison of the lateral sagittal and costoclavicular approach","volume":"43","author":"Songthamwat","year":"2018","journal-title":"Reg Anesth Pain Med"},{"key":"R21-20251001","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/AAP.0000000000000566","article-title":"Ultrasound-guided costoclavicular brachial plexus block: Sonoanatomy, technique, and block dynamics","volume":"42","author":"Li","year":"2017","journal-title":"Reg Anesth Pain 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Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group","volume":"283","author":"Stroup","year":"2000","journal-title":"JAMA"},{"key":"R33-20251001","doi-asserted-by":"crossref","first-page":"e1000097","DOI":"10.1371\/journal.pmed.1000097","article-title":"Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement","volume":"6","author":"Moher","year":"2009","journal-title":"PLoS Med"},{"key":"R34-20251001","first-page":"Ed000142","article-title":"Updated guidance for trusted systematic reviews: A new edition of the Cochrane Handbook for Systematic Reviews of Interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"R35-20251001","doi-asserted-by":"crossref","first-page":"e031854","DOI":"10.1136\/bmjopen-2019-031854","article-title":"Systematic review and meta-analysis of the incidence and prevalence and 30-year trend of inflammatory bowel diseases in Asia: A study protocol","volume":"9","author":"Safarpour","year":"2019","journal-title":"BMJ Open"},{"issue":"3","key":"R36-20251001","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1111\/biom.12817","article-title":"Quantifying publication bias in meta-analysis","volume":"74","author":"Lin","year":"2018","journal-title":"Biometrics."},{"issue":"1","key":"R37-20251001","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1186\/s12874-020-00966-4","article-title":"Methodological tools and sensitivity analysis for assessing quality or risk of bias used in systematic reviews published in the high-impact anesthesiology journals","volume":"20","author":"Maru\u0161i\u0107","year":"2020","journal-title":"BMC Med Res Methodol."},{"issue":"10","key":"R38-20251001","doi-asserted-by":"crossref","first-page":"922","DOI":"10.4103\/ija.ija_623_24","article-title":"Sensitivity and subgroup analysis in a meta-analysis\u2013What we should know?","volume":"68","author":"Nair","year":"2024","journal-title":"Indian Journal of Anaesthesia."},{"issue":"3","key":"R39-20251001","doi-asserted-by":"crossref","first-page":"659","DOI":"10.2307\/2336502","article-title":"Discrete sequential boundaries for clinical trials","volume":"70","author":"Lan","year":"1983","journal-title":"Biometrika"},{"issue":"1","key":"R40-20251001","doi-asserted-by":"crossref","first-page":"162","DOI":"10.4103\/sja.sja_715_23","article-title":"Understanding the trial sequential analysis graph in meta-analysis","volume":"18","author":"Nair","year":"2024","journal-title":"Saudi J Anaesth."},{"key":"R41-20251001","first-page":"e62586","article-title":"Diaphragmatic and pulmonary functions following an ultrasound-guided supraclavicular approach versus a costoclavicular approach of a brachial plexus block: A randomized study","volume":"16","author":"Saraswat","year":"2024","journal-title":"Cureus"},{"key":"R42-20251001","doi-asserted-by":"crossref","first-page":"442","DOI":"10.4097\/kja.22718","article-title":"Hemidiaphragmatic paralysis after costoclavicular approach versus other brachial plexus blocks in upper limb surgery: A meta-analysis","volume":"76","author":"Koo","year":"2023","journal-title":"Korean J Anesthesiol"},{"key":"R43-20251001","doi-asserted-by":"crossref","first-page":"606","DOI":"10.4103\/ija.ija_1124_23","article-title":"Comparison of the classical approach and costoclavicular approach of ultrasound-guided infraclavicular block: A systematic review and meta-analysis","volume":"68","author":"Garg","year":"2024","journal-title":"Indian J Anaesth"}],"container-title":["Journal of Anaesthesiology Clinical Pharmacology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_415_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:51:13Z","timestamp":1786647073000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/joacp.joacp_415_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,9]]},"references-count":43,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/joacp.joacp_415_24","relation":{},"ISSN":["0970-9185","2231-2730"],"issn-type":[{"value":"0970-9185","type":"print"},{"value":"2231-2730","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,9]]},"assertion":[{"value":"2024-08-16","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-10-04","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}