Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 72512

Case ReportDiscussionConclusionReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"

Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018

Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."

Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018

Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."

Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018

Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."

Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
On Sep 2018

Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."

Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata

Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
On Aug 2018

Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".

Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
On Aug 2018

Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".

Dr. Mamta Gupta
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018

Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.

Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."

Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
On May 11,2011

Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."

Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
On April 2011

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.

Dr. Anuradha
On Jan 2020

Important Notice

Case report
Year : 2007 | Month : August | Volume : 1 | Issue : 4 | Page : 276 - 283 Full Version

Delayed Respiratory Arrest in a Patient Following Interscalene Block: A Case Report with an Overview of Complications Associated with Interscalene Approach to Brachial Plexus Block

Published: August 1, 2007 | DOI:

Advanced Medical and Dental Institute, Universiti Sains Malaysia, No. 29, Lorong Bertam Indah 4/9, !3200, Kepala Batas, Penang, Malaysia.

Correspondence Address :
Dr. Aditya Nath Shukla. Lecturer in Anaesthesiology, Advanced Medical and Dental Institute, Universiti Sains Malaysia, No. 29, Lorong Bertam Indah 4/9, !3200, Kepala Batas, Penang, Malaysia. Tel.: +604-5752006; fax: +605751990; e-mail:

Interscalene approach to the brachial plexus is the most proximal approach to brachial plexus and is utilised commonly for procedures performed on or near the shoulder joint and arm (1). This method of regional anaesthesia saves the patients from pain, nausea and vomiting, which are associated with general anaesthesia.
Although interscalene approach to brachial plexus block is quite safe, a wide variety of complications have been reported with it.

We report a case where a 56-year-old lady with flail chest and shoulder injury was undergoing a surgical toilet and debridement, with application of external fixator on left humerus upper shaft involving left shoulder joint, under interscalene block. The patient landed in cardiorespiratory arrest about half an hour in the procedure and nearly 50 minutes after the block was administered.

Case Report

A 56-year-old female, 156 cm tall, weighing 56 kg, with ASA (American Society of Anesthesiologists) status III, was admitted to the hospital after having met with a road traffic accident.

The patient was a known case of chronic obstructive airway disease (COAD), had a chest injury with fracture of ribs 4–8 on left side, leading to a flail segment on left side, and compound Fracture left upper 1/3 humerus extending to involve the left shoulder joint. The patient was examined, investigated and excluded for any pneumothorax. Chest X-Ray had signs of COAD and fracture 4–8 ribs left side, and was otherwise unremarkable. The patient had a breath holding time of ~20 seconds. No other systemic abnormality was documented on history and examination and investigations otherwise were in the normal limit.

In view of the respiratory status and chest injury to patient it was decided to perform the surgery under interscalene approach to brachial plexus block.

Before starting with the procedure, patient was examined by a thoracic surgeon who advised strapping of the flail segment during the perioperative period. Accordingly, flail segment was strapped before taking up the patient.

The patient was placed supine with neck turned to other side. Block was performed using a 21 G, 25 mm needle. The needle was introduced on the left side in the interscalene grove, at the level of cricoid cartilage. After eliciting paraesthesia and negative aspiration, block was induced with 20 ml of 2% lignocaine with 1:200,000 epinephrine and 20 ml of 0.5% of bupivacaine, with negative aspiration performed initially and at every 10 ml in between. Pain experienced by patient gradually abolished. Adequacy of sensory effect was tested by pinprick after 20 minutes and was found to be adequate.

Patient was provided oxygen by nasal cannouae at 3 lpm and injection midazolam 2 mg iv.
At this point, the surgical team was allowed to proceed with the procedure. After about 20 minutes in the procedure, it was noticed that the patient’s voice had diminished in intensity and over the next 10 minutes the patient gradually landed in aphonia. Respiration and other vital parameters were normal till this time. About 5 minutes later, the patient suddenly landed in apnoea and her heart rate started decreasing and she became unconscious. The patient was given injection atropine 0.6 mg iv and intubated immediately, and positive pressure ventilation was instituted. Patient’s heart rate rose and settled in the normal range for the remainder of the procedure. The patient was ventilated with 100% oxygen initially for 20 minutes and then with O2:N2O in a 1:1 ratio. Her vitals signs remained stable otherwise throughout the rest of surgery; no further arrhythmia was documented. Additional midazolam 2 mg iv was provided with intubation. Patient’s spontaneous respiratory efforts resurfaced over next 30 minutes and from then onwards patient’s respiration was assisted. In the next 30 minutes, the patient had sufficient respiratory efforts to maintain the ventilation and was left on spontaneous ventilation on Ayer’s T Piece with O2 at 4 lpm. By the time the surgical procedure was finished, the patient was awake and fully following verbal commands and was extubated.

Detailed examination of the patient in postoperative, and a day later, failed to reveal any persistent neurological deficit. The patient was discharged after 7 days.


Shoulder procedures are associated with severe pain. Interscalene brachial plexus block is an effective and reliable method of providing anaesthesia, with the persistent effect providing for some postoperative pain relief. Further, the technique is free from other side effects associated with general anaesthesia and also provides for good operating conditions with reduced blood loss, excellent muscle relaxation, reduced cost of treatment, etc. The performance of interscalene block with a standard technique and drug application is associated with a high success rate and with very few long-term complications.

The major acute complications/side effects associated with interscalene block are respiratory depression (due to associated ipsilateral phrenic block), intravascular injection that may lead to seizures and cardiac arrest, pneumothorax, epidural and spinal anaesthesia, Horner’s syndrome (ipsilateral cervical sympathetic block), and hoarseness and dysphagia (ipsilateral recurrent laryngeal nerve block) (2).

The case we described was of a young elderly lady with coexistent COAD and a flail segment; the patient required an urgent surgical intervention, as she had a compound fracture with intra-articular extension. Because of the respiratory status and coexistent flail segment in the patient, we wished to avoid general anaesthesia in her. Only interscalene approach to brachial plexus was suitable for her, as the surgery involved working on and in close proximity with the shoulder joint.
The performance of block was easy, as described by Winnie’s technique. The sensory block was well established in the expected time. The surgery progressed well in the initial stage without any problem. However, about 40 minutes later, the problem started progressing to the extent where respiratory assistance was required. Subsequently, after another 30 minutes, spontaneous respiratory efforts were evident again and sufficient strength was restored over the next 30 minutes. Subsequently, the patient had complete recovery without any residual deficit.

The course of events in this case suggests delayed migration of local anaesthetic agent in the central neural space. However, whether the extension was into the extradural or subarachnoid space could not be commented on with certainty.

The central migration of the local anaesthetic agents in interscalene block is a known entity, and, though infrequently seen, cases have been documented in this regard. However, it usually occurs much earlier than in the case discussed. Also in the literature available, no case reported had coexistent acute chest injury. Further, the temporary strapping performed beforehand did provide the cover during assisted respiration.

Central neuraxial anaesthesia has been reported as the complication of interscalene block despite locating the brachial plexus easily with paraesthesia. This has usually been characterised by the fall of blood pressure and heart rate, extension of sensory and motor block outside the dermatomes expected for interscalene block, with or without involvement of the phrenic nerves. The patient may or may not retain the consciousness. The complication can present after interscalene block at varied time intervals, immediately following block to those delayed by up to 1 hour.

The central migration of drug can be to the spinal, epidural or subdural space, and indeed it may be difficult to identify the exact cause for the complication. However, the subdural spread can be suspected if the spread of block outside the brachial plexus is much patchy in distribution and is associated with minimal sympathetic block, and the interval between the initial block and onset of symptoms is too long (3). Spinal and epidural spreads are associated with relatively denser block with more profound sympathetic block. The motor component of the block is more in case of spinal spread.

This central neuraxial b


We all are aware that no procedure is absolutely safe and adequate for all patients, and interscalene approach to brachial plexus block is no exception from this rule. However, if following precautions are observed while performing interscalene block, then the complications associated with it can be minimised.

1. Always perform the block on an awake patient or patient under very light sedation
2. Any increase in pain, especially severe pain, should warn the anaesthetist of an intraneural injection and the adjustment in needle position should be made accordingly.

3. Avoid performing the block in an uncomfortable non-cooperative patient. General anaesthesia can be the alternative anaesthetic technique in these patients and then other approaches for postoperative analgesia can be adopted.

4. Always use a short bevelled needle ~25–35 mm in size, as most of the complications associated with block are encountered when one probes deeper for locating the brachial plexus.

5. Needle should be entered in the interscalene groove with a posteroinferior direction.

6. As interscalene block is a superficial block, inability to localise brachial plexus at 1–1.5 should prompt one that the needle may be in wrong plane and one should withdraw and re-enter rather than going more deep.

7. Each patient before undergoing interscalene block must be evaluated for the status of contralateral phrenic and recurrent laryngeal nerve function and if suspected should have a proper ENT examination.

8. Successful initiation of block and surgery does not guarantee outcome, as late complications can occur and constant vigilance and management of respiratory and circulatory system are mandatory.

9. There should be greater education and training for the nerve blocks to the trainee anaesthetist so that persons experienced in its performance are doing it, because complications are less in informed and experienced hands.

10. The greater use of ultrasonographic guidance may further increase the safety of procedure.

11. The physician should ensure that the patient does not move unexpectedly during the procedure and be prepared for it.


Daniel A. Interscalene brachial plexus block. World Anesth Online 1998;9(5).
Urban Michael K. The interscalene block for shoulder surgery. Tech Shoulder Elbow Surg 2004;5(2):61–5.
Tetzlaff JE, Yoon HJ, Dilger J, Brems J. Subdural anesthesia as a complication of an interscalene block brachial plexus block a case report. Regional Anesth 1994;19(5):357–9.
Benumof Jonathan L. Permanent loss of cervical spinal cord function associated with interscalene block performed under general anesthesia. Anesthesiology 2000;93(6):1541–4.
Passante AN. Spinal anesthesia and permanent neurological deficit after interscalene block. Anesth Analg 1996;82(4):873–4.
Norris D, Klahsen A, Milne B. Delayed bilateral spinal anesthesia following interscalene brachial plexus block. Can J Anesth 1997;44(5):572.
Gregoretti S. Case of high spinal anesthesia as a complication of an interscalene brachial plexus block. Minerva Anesthesiol 1980;46(3):437–9.
Walter M, Rogalla P, Spies C, Kox WJ, Volk T. Intrathecal placement of an interscalene plexus catheter. Anaesthesist 2005;54(3):215–9.
Chelly JE, Greger J, Gebhard R, Casati A. How to prevent catastrophic complications when performing interscalene blocks. Anesthesiology 2001;95(5):1302.
Urmey WF, Gloeggler PJ. Pulmonary function changes during interscalene brachial plexus block: effects of decreasing local anesthetic injection volume. Regional Anesth 1993;18(4):244–9.
Sala-Blanch X, Lazaro JR, Correa J, Gomez-Fernandez M. Phrenic nerve block caused by interscalene bracheal plexus block: effects of digital pressure and a low volume of local anesthetic. Regional Anesth Pain Med 1999;24(3):231–5.
Caputo F, Ventura R. Brachial plexus block Effect of low interscalenic approach on phrenic nerve paresis. Minerva Anesthesiol 2000;66(4):195–9.
Rau RH, Chan YL, Chaun HI, et al. Dyspnea resulting from phrenic nerve para

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)