Permanent upper trunk plexopathy after interscalene brachial plexus block

Journal of Clinical Monitoring and Computing
Merce AvellanetMiguel A Gonzalez-Viejo

Abstract

Interscalene brachial plexus block (IBPB) has been widely used in shoulder surgical procedures. The incidence of postoperative neural injury has been estimated to be as high as 3 %. We report a long-term neurologic deficit after a nerve stimulator assisted brachial plexus block. A 55 year-old male, with right shoulder impingement syndrome was scheduled for elective surgery. The patient was given an oral dose of 10 mg of diazepam prior to the nerve stimulator assisted brachial plexus block. The patient immediately complained, as soon as the needle was placed in the interscalene area, of a sharp pain in his right arm and he was sedated further. Twenty-four hours later, the patient complained of severe shoulder and arm pain that required an increased dose of analgesics. Severe peri-scapular atrophy developed over the following days. Electromyography studies revealed an upper trunk plexus injury with severe denervation of the supraspinatus, infraspinatus and deltoid muscles together with a moderate denervation of the biceps brachii muscle. Chest X-rays showed a diaphragmatic palsy which was not present post operatively. Pulmonary function tests were also affected. Phrenic nerve paralysis was still present 18 months after the block ...Continue Reading

References

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Citations

Apr 16, 2016·Journal of Shoulder and Elbow Surgery·Carlos A UquillasAndrew S Rokito
Jan 9, 2017·Journal of Clinical Monitoring and Computing·Jan F A Hendrickx, Andre M De Wolf
Apr 29, 2019·Current Treatment Options in Neurology·Elena ShaninaRobert Glenn Smith

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