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iamp;#39;m sure that you and your colleagues often face this in your everyday practice we all take care of patients who would be beneficiary of interscale and analgesia but the presence of respiratory disease makes it uncomfortable to perceive it in interscale and break your plexus block because of the possibility of the diaphragmatic paralysis and the phrenic nerve block and indeed this is one of the most common questions that many of nesoraamp;#39;s boutique workshops and cme symposia delegates always ask so how to approach interventional analgesia in these patients how to accomplish analgesia of the shoulder using blocks without risking the phrenic nerve block and diaphragmatic paralysis and respiratory demise thereamp;#39;s one short answer to the question and asura has also developed several algorithms in its compendium of regional anesthesia to assist the clinical decision making in this clinical scenario using these strategies that we teach at nysora eliminates the guesswork