Abstract
The incidence of perioperative brachial plexus injury is not precisely known. Retrospective studies suggested that brachial plexus injuries represent about 20-28% of the total perioperative peripheral nerve injuries. There are various risk factors for brachial plexus injury under anesthesia and surgery including preexisting disease, preexisting abnormal anatomical features, poor positioning, long surgical duration, hypotension, and hypothermia. Brachial plexus injury can be classified into preganglionic, postganglionic, or mixed pre and postganglionic. The most common perioperative brachial plexus injury are ulnar nerve injury, upper/middle trunk injury and lower trunk injury. Pathologically, a brachial plexus injury is classified into neuropraxia, axonotmesis, and neurotemsis. Such pathologic classification has a prognostic value and can determine treatment strategy. Treatment of brachial plexus injury is essentially conservative. If surgical intervention is necessary, it is usually a lengthy procedure associated with specific anesthetic considerations including pressure care, temperature control, adequate fluid therapy to maintain normal volume status, prolonged ventilation strategy, control of blood sugar and acid-base balance, electromyography testing, and thromboembolic prophylaxis.
The original version of this chapter was revised. An erratum to this chapter can be found at https://doi.org/10.1007/978-981-15-0458-7_33
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Change history
16 July 2020
In chapter 2, the abstract content was inadvertently duplicated as first paragraph of the chapter in the original version of this book. It has been corrected now and duplication of abstract content was removed and updated with correct stem cells content.
References
Welch MB, Brummett CM, Welch TD, Tremper KK, Shanks AM, Guglani P, Mashour GA. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Anesthesiology. 2009;111(3):490–7.
Warner M, Warner D, Matsumoto J, Harper M, Schroeder D, Maxson P. Ulnar neuropathy in surgical patients. Anesthesiology. 1999;90:54–9.
Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: a review of 22 cases. Br J Anaesth. 1997;79(4):440–5.
Nichols AW. Diagnosis and management of thoracic outlet syndrome. Curr Sports Med Rep. 2009;8(5):240–9.
Hewson DW, Bedforth NM, Hardman JG. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia. 2018;73(Suppl 1):51–60.
Cooper DE, Jenkins RS, Bready L, Rockwood CA. The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery. Clin Orthop. 1988;228:33–41.
Anonymous. Practice advisory for the prevention of perioperative peripheral neuropathies: a report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology. 2000;92:1168–82.
Bird TM, Strunin L. Anaesthetic considerations for microsurgical repair of limbs. Can Anaesth Soc J. 1984;31(1):51–60.
Dodds C. Prolonged anaesthesia for plastic and reconstructive surgery. Curr Anaesth Crit Care. 1996;7:20–4.
Netter FH. Atlas of human anatomy. 7th ed. North York: Elsevier; 2018.
Moran SL, Steinmann SP, Shin AY. Adult brachial plexus injuries: mechanism, patterns of injury, and physical diagnosis. Hand Clin. 2005;21(1):13–24.
Park HR, Lee GS, Kim IS, Chang J-C. Brachial plexus injury in adults. Nerve. 2017;3(1):1–11.
Chandler MH, Dimatteo L, Hasenboehler EA, Temple M. Intraoperative brachial plexus injury during emergence following movement with arms restrained: a preventable complication? Patient Saf Surg. 2007;1:8. (page 1–5).
Dillin L, Hoaglund FT, Scheck M. Brachial neuritis. J Bone Joint Surg Am. 1985;67:878–80.
Landi A, Copeland S. Value of the Tinel sign in brachial plexus lesions. Ann R Coll Surg Engl. 1979;61:470–1.
Sawyer RJ, Richmond MN, Hickey JD, Jarrratt JA. Peripheral nerve injuries associated with anaesthesia. Anaesthesia. 2000;55(10):980–91.
Yoshikawa T, Hayashi N, Yamamoto S, Tajiri Y, Yoshioka N, Masumoto T, Mori H, Abe O, Aoki S, Ohtomo K. Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics. 2006;26(Suppl 1):S133–43.
Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol. 2010;17(4):414–20.
Belzberg AJ, Dorsi MJ, Storm PB, Moriarity JL. Surgical repair of brachial plexus injury: a multinational survey of experienced peripheral nerve surgeons. J Neurosurg. 2004;101(3):365–76.
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El Beheiry, H. (2020). Management of Patient with Brachial Plexus Injury. In: Prabhakar, H., Rajan, S., Kapoor, I., Mahajan, C. (eds) Problem Based Learning Discussions in Neuroanesthesia and Neurocritical Care. Springer, Singapore. https://doi.org/10.1007/978-981-15-0458-7_2
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