The Prevention of Injuries of the Brachial Plexus Secondary to Malposition of the Patient During Surgery

Positioning patients for spine surgery: Avoiding uncommon position-related complications

“…The reported incidence of brachial plexus injury in non-cardiac surgery is 0.02% [62] . The main mechanisms of brachial plexus injury are compression and stretch.…”

Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies

“…Fourteen 9 -16,18 -20,22,23,25 were case reports or studies with descriptive information only. Eight of these articles 9,[12][13][14][15]18,19,25 reported brachial plexus neuropathies occurring with arm abduction greater than 90°, and two 16,23 reported brachial plexus neuropathies occurring with arm abduction of 90°. Three articles 17,21,24 reported statistical comparisons, only one 17 of which was a randomized clinical trial.…”

“…Ten articles 10,13,27,28,[40][41][42][43][44][45] report peripheral neuropathies occurring when upper extremity protective padding was used. Three 10,13,44 are case reports of brachial plexopathy, five 27,28,42,43,45 are case reports of ulnar neuropathy, and one 40 is a case report of anterior interosseous nerve injury (category B3 evidence). One retrospective assessment 41 of the placement of towels under the scapula during median sternotomy reports 4 cases of brachial plexus injury (category B2 evidence).…”

“…The majority of consultants and ASA membership respondents agreed with the following survey items: (1) a focused preoperative medical history and a focused preoperative examination to identify patients at risk for the development of peripheral neuropathies during the perioperative period; (2) upper extremity position should be periodically assessed during procedures; (3) limiting abduction of the arm(s) in a supine or prone patient may decrease the risk of brachial plexus neuropathy; (4) specific forearm position(s) in a supine patient with arm(s) tucked at the side or abducted on an arm board may decrease the risk of ulnar neuropathy; (5) pressure in the spiral groove of the humerus from prolonged contact with a hard surface may increase the risk of radial neuropathy; (6) extension of the elbow in an anesthetized supine patient beyond the normal range of extension that is comfortable during the preoperative examination may increase the risk of median neuropathy; (7) pressure near the fibular head from contact with a hard surface or a rigid support may increase the risk of peroneal neuropathy; (8) padded arm boards may decrease the risk of upper extremity neuropathies; (9) a chest roll placed under the "downside" (dependent) lateral thorax in a patient who is positioned laterally may decrease the risk of brachial plexus neuropathy in the down arm; (10) specific padding (e.g., foam or gel pads) at the elbow may decrease the risk of ulnar neuropathy; (11) specific padding to prevent contact of the peroneal nerve (at the fibular head) with a hard surface may decrease the risk of peroneal neuropathy; (12) in some circumstances, the use of padding may increase the risk of peripheral neuropathies; (13) shoulder braces (commonly placed over the acromioclavicluar joint) to prevent a patient from sliding cephalad when placed in a steep head-down position may increase the risk of brachial plexus neuropathy; (14) examining the patient in the PACU may lead to early recognition of peripheral neuropathy; and (15) documentation on an anesthetic record of specific positioning actions during the care of a patient is important. Items for which no majority agreement was indicated were as follows: (1) flexion of the elbow may increase the risk of ulnar neuropathy; (2) stretching of the hamstring muscle group (e.g., biceps femoris muscle) beyond the normal range of motion that is comfortable during the preoperative assessment may increase the risk of sciatic neuropathy; (3) extension of the hip in an anesthetized supine patient beyond the normal range of extension that is comfortable during the preoperative examination (e.g., hyperlordosis) may increase the risk of femoral neuropathy; and (4) the use of an automated blood pressure cuff on the arm may increase the risk of ulnar, radial, or median neuropathy.…”

Brachial Plexus Neuropraxia after CT-Guided Radiofrequency Ablation in a Patient with a Narrow Costoclavicular Space: A Case Report

“…Brachial plexus neuropraxia during anaesthesia has been reported in multiple different surgeries and is caused by the stretching and compression of the plexus secondary to positioning [1]. Anatomical abnormalities of the thoracic outlet with which the plexus runs through as a contributory aggravating cause of such injuries have however been less discussed.…”