Evaluation of Diaphragm Movement After an Interscalene Block

This study will be run concurrently with two other studies comparing bupivacaine to Liposomal
Bupivacaine in shoulder surgeries. We will use already randomized patients for our
randomization process. For this study in particular we will use an ultrasound machine to scan
the diaphragm of any patient who had an Interscalene Block for Total Shoulder Arthroplasy or
Rotator Cuff Repair. Patients are to be scanned in an upright sitting position and scanned
from a low intercostal or subcostal approach using the liver or spleen as an acoustic window.
M Mode will be applied and the range of diaphragmatic movement from the resting expiratory
position to deep inspiration (sigh test) will be recorded as was the range of diaphragmatic
movement from resting expiratory position when quickly inspiring through the nose (sniff
test). The blocks will be done regardless of the study as they are standard of care for pain
control. The only intervention is ultrasound examination of the patient's diaphragm at
baseline, 3 hours post block in recovery room and on post-operative day 1, and basic
spirometry to record FEV1 and FVC via a portable spirometer at the same time points. If
patients did stay in hospital on postoperative day 2 we would also evaluate their diaphragm
function.

Inclusion Criteria:

- All patients age 18 years and older who are scheduled for shoulder surgery with
interscalene block and remain in the hospital for more than 24 hours that are being
randomized into a bupivacaine versus liposomal bupivacaine interscalene block study.

Exclusion Criteria:

- Non English speaking patients.