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BMJ Case Rep ; 14(11)2021 Nov 29.
Article in English | MEDLINE | ID: covidwho-1546474

ABSTRACT

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient's quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.


Subject(s)
Brachial Plexus Neuropathies , Brachial Plexus , Endometriosis , Adult , Brachial Plexus Neuropathies/etiology , Endometriosis/surgery , Female , Humans , Musculocutaneous Nerve , Quality of Life
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