The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
권호 표지
DOI QR코드

DOI QR Code

Brachial Plexus Injury as a Complication after Nerve Block or Vessel Puncture

  • Kim, Hyun Jung (Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine) ;
  • Park, Sang Hyun (Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine) ;
  • Shin, Hye Young (Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine) ;
  • Choi, Yun Suk (Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine)
  • Received : 2014.05.28
  • Accepted : 2014.06.13
  • Published : 2014.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Brachial plexus injury is a potential complication of a brachial plexus block or vessel puncture. It results from direct needle trauma, neurotoxicity of injection agents and hematoma formation. The neurological presentation may range from minor transient pain to severe sensory disturbance or motor loss with poor recovery. The management includes conservative treatment and surgical exploration. Especially if a hematoma forms, it should be removed promptly. Comprehensive knowledge of anatomy and adept skills are crucial to avoid nerve injuries. Whenever possible, the patient should not be heavily sedated and should be encouraged to immediately inform the doctor of any experience of numbness/paresthesia during the nerve block or vessel puncture.

Keywords

References

  1. Iwata T, Mitoro M, Kuzumoto N. Feasibility of early and repeated low-dose interscalene brachial plexus block for residual pain in acute cervical radiculopathy treated with NSAIDS. Korean J Pain 2014; 27: 125-32. https://doi.org/10.3344/kjp.2014.27.2.125
  2. Johnson PS, Greifenstein FE. Brachial plexus block anesthesia. J Mich State Med Soc 1955; 54: 1329-31.
  3. Woolley EJ, Vandam LD. Neurological sequelae of brachial plexus nerve block. Ann Surg 1959; 149: 53-60. https://doi.org/10.1097/00000658-195901000-00006
  4. Karakaya D, Baris S, Guldogus F, Incesu L, Sarihasan B, Tur A. Brachial plexus injury during subclavian vein catheterization for hemodialysis. J Clin Anesth 2000; 12: 220-3. https://doi.org/10.1016/S0952-8180(00)00144-6
  5. Trentman TL, Rome JD, Messick JM Jr. Brachial plexus neuropathy following attempt at subclavian vein catheterization. Case report. Reg Anesth 1996; 21: 163-5.
  6. Urban MK, Urquhart B. Evaluation of brachial plexus anesthesia for upper extremity surgery. Reg Anesth 1994; 19: 175-82.
  7. Fanelli G, Casati A, Garancini P, Torri G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg 1999; 88: 847-52.
  8. Porzionato A, Montisci M, Manani G. Brachial plexus injury following subclavian vein catheterization: a case report. J Clin Anesth 2003; 15: 582-6. https://doi.org/10.1016/j.jclinane.2003.02.009
  9. Jernigan WR, Gardner WC, Mahr MM, Milburn JL. Use of the internal jugular vein for placement of central venous catheter. Surg Gynecol Obstet 1970; 130: 520-4.
  10. Chitwood RW, Shepard AD, Shetty PC, Burke MW, Reddy DJ, Nypaver TJ, et al. Surgical complications of transaxillary arteriography: a case-control study. J Vasc Surg 1996; 23: 844-9. https://doi.org/10.1016/S0741-5214(96)70247-1
  11. Tsao BE, Wilbourn AJ. Infraclavicular brachial plexus injury following axillary regional block. Muscle Nerve 2004; 30: 44-8. https://doi.org/10.1002/mus.20066
  12. Madison SJ, Ilfeld BM. Peripheral nerve blocks. In: Morgan & Mikhail's clinical anesthesiology. 5th ed. Edited by Butterworth JF, Mackey DC, Wasnick JD. New York (NY), McGraw-Hill. 2013, pp 981-3.
  13. Jenkins GW, Kemnitz CP, Tortora GJ. Anatomy and physiology from science to life. Hoboken (NJ), John Wiley & Sons, Inc. 2007.
  14. Mian A, Chaudhry I, Huang R, Rizk E, Tubbs RS, Loukas M. Brachial plexus anesthesia: a review of the relevant anatomy, complications, and anatomical variations. Clin Anat 2014; 27: 210-21. https://doi.org/10.1002/ca.22254
  15. Selander D, Edshage S, Wolff T. Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks. Acta Anaesthesiol Scand 1979; 23: 27-33. https://doi.org/10.1111/j.1399-6576.1979.tb01417.x
  16. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008; 33: 253-8. https://doi.org/10.1097/00115550-200805000-00010
  17. Orebaugh SL, Williams BA, Vallejo M, Kentor ML. Adverse outcomes associated with stimulator-based peripheral nerve blocks with versus without ultrasound visualization. Reg Anesth Pain Med 2009; 34: 251-5. https://doi.org/10.1097/AAP.0b013e3181a3438e
  18. Ben-David B, Barak M, Katz Y, Stahl S. A retrospective study of the incidence of neurological injury after axillary brachial plexus block. Pain Pract 2006; 6: 119-23. https://doi.org/10.1111/j.1533-2500.2006.00073.x
  19. Bernard RW, Stahl WM. Subclavian vein catheterizations: a prospective study. I. Non-infectious complications. Ann Surg 1971; 173: 184-90. https://doi.org/10.1097/00000658-197102000-00002
  20. Ryan JA Jr, Abel RM, Abbott WM, Hopkins CC, Chesney TM, Colley R, et al. Catheter complications in total parenteral nutrition. A prospective study of 200 consecutive patients. N Engl J Med 1974; 290: 757-61. https://doi.org/10.1056/NEJM197404042901401
  21. Sznajder JI, Zveibil FR, Bitterman H, Weiner P, Bursztein S. Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986; 146: 259-61. https://doi.org/10.1001/archinte.1986.00360140065007
  22. Fuller GN, Dick JP, Colquhoun IR. Brachial plexus compression by hematoma following jugular puncture. Neurology 1994; 44: 775-6. https://doi.org/10.1212/WNL.44.4.775
  23. Paschall RM, Mandel S. Brachial plexus injury from percutaneous cannulation of the internal jugular vein. Ann Emerg Med 1983; 12: 58-60.
  24. Jackson L, Keats AS. Mechanism of brachial plexus palsy following anesthesia. Anesthesiology 1965; 26: 190-4. https://doi.org/10.1097/00000542-196503000-00009
  25. Garcia-Fages LC, Castillo J, Gomar C, Villalonga A, Nalda MA. Transient block of the brachial plexus after catheterization of the subclavian vein. Ann Fr Anesth Reanim 1990; 9: 93-4. https://doi.org/10.1016/S0750-7658(05)80043-7
  26. Goven'ko FS, Rogulov VA. Injury of the brachial plexus after catheterization of the subclavian vein in a 6-month-old child. Vestn Khir Im I I Grek 1983; 130: 121-2.
  27. Defalque RJ. Percutaneous catheterization of the internal jugular vein. Anesth Analg 1974; 53: 116-21.
  28. Daily PO, Griepp RB, Shumway NE. Percutaneous internal jugular vein cannulation. Arch Surg 1970; 101: 534-6. https://doi.org/10.1001/archsurg.1970.01340280086023
  29. Matz R. Complications of determining the central venous pressure. N Engl J Med 1965; 273: 703. https://doi.org/10.1056/NEJM196509232731308
  30. Whitlock EL, Brenner MJ, Fox IK, Moradzadeh A, Hunter DA, Mackinnon SE. Ropivacaine-induced peripheral nerve injection injury in the rodent model. Anesth Analg 2010; 111: 214-20.
  31. Gentili F, Hudson AR, Hunter D. Clinical and experimental aspects of injection injuries of peripheral nerves. Can J Neurol Sci 1980; 7: 143-51.
  32. Nowill WK, Hall H, Stephen CR. Neurological complications following the use of efocaine. AMA Arch Surg 1953; 67: 738-40. https://doi.org/10.1001/archsurg.1953.01260040749011
  33. Yamashita A, Matsumoto M, Matsumoto S, Itoh M, Kawai K, Sakabe T. A comparison of the neurotoxic effects on the spinal cord of tetracaine, lidocaine, bupivacaine, and ropivacaine administered intrathecally in rabbits. Anesth Analg 2003; 97: 512-9. https://doi.org/10.1213/01.ANE.0000068885.78816.5B
  34. Radwan IA, Saito S, Goto F. The neurotoxicity of local anesthetics on growing neurons: a comparative study of lidocaine, bupivacaine, mepivacaine, and ropivacaine. Anesth Analg 2002; 94: 319-24.
  35. Selander D. Neurotoxicity of local anesthetics: animal data. Reg Anesth 1993; 18: 461-8.
  36. Neal JM. Effects of epinephrine in local anesthetics on the central and peripheral nervous systems: neurotoxicity and neural blood flow. Reg Anesth Pain Med 2003; 28: 124-34.
  37. O'Keefe DM. Brachial plexus injury following axillary arteriography. Case report and review of the literature. J Neurosurg 1980; 53: 853-7. https://doi.org/10.3171/jns.1980.53.6.0853
  38. Reiss W, Kurapati S, Shariat A, Hadzic A. Nerve injury complicating ultrasound/electrostimulation-guided supraclavicular brachial plexus block. Reg Anesth Pain Med 2010; 35: 400-1. https://doi.org/10.1097/AAP.0b013e3181e90ec9
  39. Spinner RJ, Kline DG. Surgery for peripheral nerve and brachial plexus injuries or other nerve lesions. Muscle Nerve 2000; 23: 680-95. https://doi.org/10.1002/(SICI)1097-4598(200005)23:5<680::AID-MUS4>3.0.CO;2-H
  40. Gentili F, Hudson AR, Kline D, Hunter D. Early changes following injection injury of peripheral nerves. Can J Surg 1980; 23: 177-82.
  41. Yoshikawa T, Hayashi N, Yamamoto S, Tajiri Y, Yoshioka N, Masumoto T, et al. Brachial plexus injury: clinical manifestations, conventional imaging findings, and the latest imaging techniques. Radiographics 2006; 26 Suppl 1: S133-43. https://doi.org/10.1148/rg.26si065511
  42. Shafighi M, Gurunluoglu R, Ninkovic M, Mallouhi A, Bodner G. Ultrasonography for depiction of brachial plexus injury. J Ultrasound Med 2003; 22: 631-4.
  43. Gray P. Acute neuropathic pain: diagnosis and treatment. Curr Opin Anaesthesiol 2008; 21: 590-5. https://doi.org/10.1097/ACO.0b013e32830c900c
  44. Dhir S, Tureanu L, Stewart SA. Axillary brachial plexus block complicated by cervical disc protrusion and radial nerve injury. Acta Anaesthesiol Scand 2009; 53: 411. https://doi.org/10.1111/j.1399-6576.2008.01850.x
  45. Kim DH, Murovic JA, Kline DG. Brachial plexus injury: mechanisms, surgical treatment and outcomes. J Korean Neurosurg Soc 2004; 36: 177-85.
  46. Po BT, Hansen HR. Iatrogenic brachial plexus injury: a survey of the literature and of pertinent cases. Anesth Analg 1969; 48: 915-22.
  47. Hems T. Nerve transfers for traumatic brachial plexus injury: advantages and problems. J Hand Microsurg 2011; 3: 6-10. https://doi.org/10.1007/s12593-011-0031-1
  48. Wilkinson MC, Birch R, Bonney G. Brachial plexus injury: when to amputate? Injury 1993; 24: 603-5. https://doi.org/10.1016/0020-1383(93)90123-N
  49. Pearce H, Lindsay D, Leslie K. Axillary brachial plexus block in two hundred consecutive patients. Anaesth Intensive Care 1996; 24: 453-8.
  50. Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, Sumida SM, et al. Analgesic efficacy of ultrasound-guided regional anesthesia: a meta-analysis. J Clin Anesth 2011; 23: 90-6. https://doi.org/10.1016/j.jclinane.2010.12.005
  51. Klaastad O, Sauter AR, Dodgson MS. Brachial plexus block with or without ultrasound guidance. Curr Opin Anaesthesiol 2009; 22: 655-60. https://doi.org/10.1097/ACO.0b013e32832eb7d3
  52. Hirasawa Y, Katsumi Y, Kusswetter W, Sprotte G. Experimental studies on peripheral nerve injuries caused by injection needles. Reg Anaesth 1990; 13: 11-5.
  53. Dooley J, Fingerman M, Melton S, Klein SM. Contralateral local anesthetic spread from an outpatient interscalene catheter. Can J Anaesth 2010; 57: 936-9. https://doi.org/10.1007/s12630-010-9360-y
  54. Moberg E, Dhuner KG. Brachial plexus block analgesia with xylocaine. J Bone Joint Surg Am 1951; 33-A: 884-8.
  55. Liu SS, YaDeau JT, Shaw PM, Wilfred S, Shetty T, Gordon M. Incidence of unintentional intraneural injection and postoperative neurological complications with ultrasoundguided interscalene and supraclavicular nerve blocks. Anaesthesia 2011; 66: 168-74. https://doi.org/10.1111/j.1365-2044.2011.06619.x
  56. Stan TC, Krantz MA, Solomon DL, Poulos JG, Chaouki K. The incidence of neurovascular complications following axillary brachial plexus block using a transarterial approach. A prospective study of 1,000 consecutive patients. Reg Anesth 1995; 20: 486-92.

Cited by

  1. Risk of Encountering Dorsal Scapular and Long Thoracic Nerves during Ultrasound-guided Interscalene Brachial Plexus Block with Nerve Stimulator vol.29, pp.3, 2016, https://doi.org/10.3344/kjp.2016.29.3.179
  2. Upper limb nerve injuries caused by intramuscular injection or routine venipuncture vol.12, pp.2, 2014, https://doi.org/10.17085/apm.2017.12.2.103
  3. The Effect of Single Point and Two Point Technique for Ultrasound Guided Supraclavicular Brachial Plexus Block in Patients Undergoing Elbow, Forearm and Wrist Surgeries- A Prospective Observational St vol.9, pp.10, 2020, https://doi.org/10.14260/jemds/2020/169
  4. Diagnosis and treatment of nerve injury following venipuncture - A report of two cases - vol.16, pp.3, 2021, https://doi.org/10.17085/apm.21010
  5. Erector Spinae Plane Block in the Emergency Department for Upper Extremity: A Case Report vol.5, pp.3, 2021, https://doi.org/10.5811/cpcem.2021.3.51803