REGIONAL ANESTHESIA: Edited by Admir HadzicDiaphragm-sparing brachial plexus blocks: a focused review of current evidence and their role during the COVID-19 pandemicCubillos, Javiera; Girón-Arango, Laurab; Muñoz-Leyva, FelipecAuthor Information aDepartment of Anesthesia & Perioperative Medicine, Western University, London Health Sciences Center, London, Ontario, Canada bDepartment of Anesthesia, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia cDepartment of Anesthesiology & Pain Medicine, University of Toronto, Toronto Western Hospital, University Health Network (UHN), Toronto, Ontario, Canada Correspondence to Javier Cubillos, MD, 339 Windermere Road-University Hospital, C3-127, London, ON N6A 5A5, Canada. Tel: +1 519 685 8500; e-mail: [email protected] Current Opinion in Anaesthesiology: October 2020 - Volume 33 - Issue 5 - p 685-691 doi: 10.1097/ACO.0000000000000911 Buy Metrics Abstract Purpose of review Given that COVID-19 can severely impair lung function, regional anesthesia techniques avoiding phrenic nerve paralysis are relevant in the anesthetic management of suspected/confirmed COVID-19 patients requiring shoulder and clavicle surgical procedures. The objective of this review is to provide an overview of recently published studies examining ultrasound-guided diaphragm-sparing regional anesthesia techniques for the brachial plexus (BP) to favor their preferent use in patients at risk of respiratory function compromise. Recent findings In the last 18 months, study findings on various diaphragm-sparing regional anesthesia techniques have demonstrated comparable block analgesic effectivity with a variable extent of phrenic nerve paralysis. The impact of hemi-diaphragmatic function impairment on clinical outcomes is yet to be established. Summary Existing diaphragm-sparing brachial plexus regional anesthesia techniques used for shoulder and clavicle surgery may help minimize pulmonary complications by preserving lung function, especially in patients prone to respiratory compromise. Used as an anesthetic technique, they can reduce the risk of exposure of healthcare teams to aerosol-generating medical procedures (AGMPs), albeit posing an increased risk for hemi-diaphragmatic paralysis. Reducing the incidence of phrenic nerve involvement and obtaining opioid-sparing analgesia without jeopardizing efficacy should be prioritized goals of regional anesthesia practice during the COVID-19 pandemic. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.