Traction injury of the brachial plexus confused with nerve injury due to interscalene brachial block: A case report

Ferrero-Manzanal, Francisco; Lax-Pérez, Raquel; López-Bernabé, Roberto; Betancourt-Bastidas, José Ramiro; Onzoño-Pérez, Alvaro Iñiguez de

doi:10.1016/j.ijscr.2016.08.023

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…If the diagnosis points towards a nerve injury occurring during the peri‐operative period, then it is important to recognise that injury during anaesthesia is not the same as injury caused by anaesthesia (or the anaesthetist); the most severe peri‐operative nerve injuries are often associated with surgical incision/retraction, rather than anaesthetic technique or patient positioning .…”

Section: Presentation and Management Of Peripheral Nerve Injurymentioning

confidence: 99%

Peripheral nerve injury arising in anaesthesia practice

2018

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SummaryIn this article, we will discuss the pathophysiology of peripheral nerve injury in anaesthetic practice, including factors which increase the susceptibility of nerves to damage. We will describe a practical and evidence-based approach to the management of suspected peripheral nerve injury and will go on to discuss major nerve injury patterns relating to intra-operative positioning and to peripheral nerve blockade. We will review the evidence surrounding particular strategies to reduce the incidence of peripheral nerve injury during nerve blockade, including nerve localisation methods, timing of blocks, needle techniques and design, injection pressure-monitoring and local anaesthetic and adjunct choice. Pathophysiology of peripheral nerve injuryPeripheral nerve injury during the peri-operative period can occur when a nerve is subjected to stretch, compression, hypoperfusion, direct trauma, exposure to neurotoxic material or a combination of these factors [1,2].In many cases, no clear aetiology for nerve injury is apparent [3,4]. The shared pathophysiological precipitant of these injuries is often nerve hypoperfusion and consequent ischaemia due to physical disruption of the vasa nervorum, intraneural haemorrhage and/or endoneural oedema [5]. These result in a spectrum of histological neural abnormalities ranging from impaired axoplasmic transport, axonal degeneration, Schwann cell damage, myelin destruction, segmental demyelination and complete Wallerian degeneration [6][7][8]. Depending on the severity and duration of the ischaemic insult, either temporary or permanent disruption to nerve impulse transmission can result. There is a loose relationship between the severity of the original pathophysiological mechanism, degree of nerve ischaemia and subsequent clinical presentation, although in an animal model of compression injury, the degree of histological nerve damage has been correlated with the degree and duration of compression [8].Established peripheral neuropathy, pre-existing (but subclinical) peripheral neuropathy, profound hypothermia, hypovolaemia, hypotension, hypoxaemia, electrolyte disorders, malnutrition, small or large body mass index (BMI), tobacco use and anatomical variants (such as the presence of cervical ribs) may increase the susceptibility of peripheral nerves to peri-

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Section: Presentation and Management Of Peripheral Nerve Injurymentioning

confidence: 99%

Peripheral nerve injury arising in anaesthesia practice

2018

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“…There are several factors which may contribute to brachial plexus injury in a case of long-standing spine surgery. Stretching, compression, and hyper abduction of the arm are a few to enlist [ 7 ]. In this case report, the arms were carefully positioned with adequate padding with soft gel cushions during surgery in the same manner as it has been done in numerous surgeries performed in the past.…”

Section: Discussionmentioning

confidence: 99%

Brachial Plexus Injury due to Central-line Insertion during Kypho-scoliosis Deformity Correction

Modi¹,

Goel²,

Sharma³

et al. 2021

JOCR

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Introduction: Internal Jugular Venous (IJV) cannulation or central-line insertion is frequently performed during kyphoscoliosis deformity correction surgery or spine surgery with high risk. This helps monitor central venous pressure and administer medicines when required. Although many complications of IJV cannulation have been reported in the literature, its effect on brachial plexus is not known. The objective of this paper was to report a rare complication of IJV during scoliosis surgery. Case Presentation: We reported a case of 27-year-old male who was operated for severe kyphoscoliosis correction where preoperatively IJV cannulation was done. Repeated attempts were done during IJV cannula insertion due to altered anatomy. Eventually, cannula insertion was done using ultrasound modality and surgery for correction was done. Postoperatively patient developed right upper extremity weakness and sensory loss although the clinical result of kyphoscoliosis correction was acceptable. EMG-NCV study proved it brachial plexus injury. The patient was treated with intravenous steroid and physiotherapy. The patient recovered completely within 6 months of surgery. Conclusion: We reported a case of kyphoscoliosis deformity corrective surgery where IJV cannulation led to brachial plexus injury and was eventually recovered with medications and physiotherapy. Keywords: Scoliosis correction, Central-line insertion, Brachial plexus injury.

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“…Variations in likelihoods or incidences disclosed can be at least partially explained by reliance on the providers' individual experience and practice, varying knowledge of the literature and/or varying use of other sources of information [10]. Moreover, postoperative neurological symptoms are an area of concern for both surgeons and anaesthetists alike, with causal factors ascribed to both [11]. Surgical nerve injuries can often be mistaken for block-related trauma and, generally, result in more severe peri-operative harm [11,12].…”

Section: Disclosing Riskmentioning

confidence: 99%

“…Moreover, postoperative neurological symptoms are an area of concern for both surgeons and anaesthetists alike, with causal factors ascribed to both [11]. Surgical nerve injuries can often be mistaken for block-related trauma and, generally, result in more severe peri-operative harm [11,12]. While many, if not all, anaesthesia-related variables of an anaesthesia-led clinical trial can be controlled for, the impact and influence of varying providers, including anaesthetists, surgeons, trainees, nurse anaesthetists, physician assistants, research staff and nurses, should not be ignored.…”

Section: Disclosing Riskmentioning

confidence: 99%

“…While many, if not all, anaesthesia‐related variables of an anaesthesia‐led clinical trial can be controlled for, the impact and influence of varying providers, including anaesthetists, surgeons, trainees, nurse anaesthetists, physician assistants, research staff and nurses, should not be ignored. Provider‐related sources of possible overlapping disclosure should be identified and addressed to mitigate misinterpretation and misreporting on the part of study participants [11].…”

Section: Disclosing Riskmentioning

confidence: 99%

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