Selective Median Nerve Injury after Axillary Brachial Plexus Block / 대한마취과학회지

A 25 years old male received an emergency operation for tendon repair of the right 3rd. finger under axillary brachial plexus block using a paresthesia technique. He had no specific medical problem in hand function except limitation of the right 3rd. finger flexion. After the operation, he complained about hand numbness, especially around the palm side of the 3rd. finger, and a tingling sensation which originated from the axilla to the 3rd. finger. Those symptoms did not subside, thus the patient was advised to seek rehabilitation medicine. On the 21st post operative day, EMG (Electromyography) indicated a right median nerve injury at the median branch level of the brachial plexus. The complete withdrawal of the symptoms was reported at the 7th week after the operation. In this case, the highly suggestive cause of selective median nerve injury was a direct nerve injury by injection needle or intraneural injection of local anesthetic drug during the brachial plexus block procedure. However, we didn't completely rule out the possibility of nerve damage by tourniquet and improper position.

Brachial Plexus Injury Following Axillary Brachial Plexus Block Using a Transarterial Approach: A case report / 대한마취과학회지

A 25-year-old male patient was received emergency operation, open reduction and tenorrhaphy owing to degloving injury on the dorsum of his left hand, under axillary brachial plexus block using a transarterial approach. Following operation, he revealed the signs and symptoms of brachial plexus injury such as weakness, sensory deficit and tingling sensation on his left forearm and hand. The finding on electromyography (EMG), performed on the 16th postoperative day (POD), was indicative of left incomplete brachial plexus injury, mainly in medial cord and ulnar nerve, and partially median and radial nerve at/above the axillary level. The signs and symptoms were improved slightly on POD 8 and a lot on POD 23. The complete recovery of symptoms and regeneration of injured nerve on EMG were confirmed 3 months following operation. In this case, the causative factors of brachial plexus injury were suggested in stretching of the brachial plexus due to improper positioning of injured arm during or after operation, combined with or without injury due to nerve block or tourniquet compression.