Selective Median Nerve Injury after Axillary Brachial Plexus Block / 대한마취과학회지

ABSTRACT

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.