CC BY-NC-ND 4.0 · Indian J Plast Surg 2014; 47(03): 460-464
DOI: 10.4103/0970-0358.146677
Case Report
Association of Plastic Surgeons of India

Post-operative brachial plexus neuropraxia: A less recognised complication of combined plastic and laparoscopic surgeries

Jimmy Thomas
Department of Plastic Surgery, Division of Burns, Al Wakra Hospital, Al Wakra, Qatara
› Author Affiliations
Further Information

Address for correspondence

Dr. Jimmy Thomas
Department of Plastic Surgery
Division of Burns, Al Wakra Hospital, P O Box: 82228, Al Wakra
Qatar   

Publication History

Publication Date:
26 August 2019 (online)

 

ABSTRACT

This presentation is to increase awareness of the potential for brachial plexus injury during prolonged combined plastic surgery procedures. A case of brachial plexus neuropraxia in a 26-year-old obese patient following a prolonged combined plastic surgery procedure was encountered. Nerve palsy due to faulty positioning on the operating table is commonly seen over the elbow and popliteal fossa. However, injury to the brachial plexus has been a recently reported phenomenon due to the increasing number of laparoscopic and robotic procedures. Brachial plexus injury needs to be recognised as a potential complication of prolonged combined plastic surgery. Preventive measures are discussed.


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Conflict of Interest

None declared.

  • REFERENCES

  • 1 Stangl R, Altendorf-Hofmann A, von der Emde J. Brachial plexus lesions following median sternotomy in cardiac surgery. Thorac Cardiovasc Surg 1991; 39: 360-4
  • 2 Romanowski L, Reich H, McGlynn F, Adelson MD, Taylor PJ. Brachial plexus neuropathies after advanced laparoscopic surgery. Fertil Steril 1993; 60: 729-32
  • 3 Barnett JC, Hurd WW, Rogers Jr RM, Williams NL, Shapiro SA. Laparoscopic positioning and nerve injuries. J Minim Invasive Gynecol 2007; 14: 664-72
  • 4 Gagnon J, Poulin EC. Beware of the Trendelenburg position during prolonged laparoscopic procedures. Can J Surg 1993; 36: 505-6
  • 5 Slocum HC, O′neal KC, Allen CR. Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet 1948; 86: 729-34
  • 6 Brunette KE, Hutchinson DO, Ismail H. Bilateral brachial plexopathy following laparoscopic bariatric surgery. Anaesth Intensive Care 2005; 33: 812-5
  • 7 Chin P, Poole G. Bilateral brachial plexus injury during laparoscopic sigmoid colectomy. ANZ J Surg 2003; 73: 86-8
  • 8 Jackson L, Keats AS. Mechanism of brachial plexus palsy following anesthesia. Anesthesiology 1965; 26: 190-4
  • 9 Schwartz DM, Sestokas AK, Hilibrand AS, Vaccaro AR, Bose B, Li M. et al. Neurophysiological identification of position-induced neurologic injury during anterior cervical spine surgery. J Clin Monit Comput 2006; 20: 437-44
  • 10 Lachman E, Rosenberg P, Gino G, Levine S, Goldberg S, Borstein M. Axonal damage to the left musculocutaneous nerve of the left biceps muscle during laparoscopic surgery. J Am Assoc Gynecol Laparosc 2001; 8: 453-5
  • 11 Rose MA, Kam PC. Gabapentin: Pharmacology and its use in pain management. Anaesthesia 2002; 57: 451-62
  • 12 World Health Organisation (website). WHOs pain ladder . Geneva, Switz: World Health Organization; 2010. Available from: www.who.int/cancer/palliative/painladder/en/ Accessed 2014 August 11
  • 13 Watanabe S, Bruera E. Corticosteroids as adjuvant analgesics. J Pain Symptom Manage 1994; 9: 442-5
  • 14 Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: A review of 22 cases. Br J Anaesth 1997; 79: 440-5
  • 15 Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 2010; 17: 414-20
  • 16 Klauschie J, Wechter ME, Jacob K, Zanagnolo V, Montero R, Magrina J. et al. Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 2010; 17: 504-7
  • 17 Luginbuhl A, Schwartz DM, Sestokas AK, Cognetti D, Pribitkin E. Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy. Laryngoscope 2012; 122 (01) 10-5
  • 18 Karna ST, Pandey CK, Pandey VK, Singh A. Brachial plexus injury in live related donor hepatectomy: A chart review. J Postgrad Med 2014; 60: 287-9
  • 19 Thatte MR. Monitoring to prevent brachial plexus injury. J Postgrad Med 2014; 60: 241-2

Address for correspondence

Dr. Jimmy Thomas
Department of Plastic Surgery
Division of Burns, Al Wakra Hospital, P O Box: 82228, Al Wakra
Qatar   

  • REFERENCES

  • 1 Stangl R, Altendorf-Hofmann A, von der Emde J. Brachial plexus lesions following median sternotomy in cardiac surgery. Thorac Cardiovasc Surg 1991; 39: 360-4
  • 2 Romanowski L, Reich H, McGlynn F, Adelson MD, Taylor PJ. Brachial plexus neuropathies after advanced laparoscopic surgery. Fertil Steril 1993; 60: 729-32
  • 3 Barnett JC, Hurd WW, Rogers Jr RM, Williams NL, Shapiro SA. Laparoscopic positioning and nerve injuries. J Minim Invasive Gynecol 2007; 14: 664-72
  • 4 Gagnon J, Poulin EC. Beware of the Trendelenburg position during prolonged laparoscopic procedures. Can J Surg 1993; 36: 505-6
  • 5 Slocum HC, O′neal KC, Allen CR. Neurovascular complications from malposition on the operating table. Surg Gynecol Obstet 1948; 86: 729-34
  • 6 Brunette KE, Hutchinson DO, Ismail H. Bilateral brachial plexopathy following laparoscopic bariatric surgery. Anaesth Intensive Care 2005; 33: 812-5
  • 7 Chin P, Poole G. Bilateral brachial plexus injury during laparoscopic sigmoid colectomy. ANZ J Surg 2003; 73: 86-8
  • 8 Jackson L, Keats AS. Mechanism of brachial plexus palsy following anesthesia. Anesthesiology 1965; 26: 190-4
  • 9 Schwartz DM, Sestokas AK, Hilibrand AS, Vaccaro AR, Bose B, Li M. et al. Neurophysiological identification of position-induced neurologic injury during anterior cervical spine surgery. J Clin Monit Comput 2006; 20: 437-44
  • 10 Lachman E, Rosenberg P, Gino G, Levine S, Goldberg S, Borstein M. Axonal damage to the left musculocutaneous nerve of the left biceps muscle during laparoscopic surgery. J Am Assoc Gynecol Laparosc 2001; 8: 453-5
  • 11 Rose MA, Kam PC. Gabapentin: Pharmacology and its use in pain management. Anaesthesia 2002; 57: 451-62
  • 12 World Health Organisation (website). WHOs pain ladder . Geneva, Switz: World Health Organization; 2010. Available from: www.who.int/cancer/palliative/painladder/en/ Accessed 2014 August 11
  • 13 Watanabe S, Bruera E. Corticosteroids as adjuvant analgesics. J Pain Symptom Manage 1994; 9: 442-5
  • 14 Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: A review of 22 cases. Br J Anaesth 1997; 79: 440-5
  • 15 Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 2010; 17: 414-20
  • 16 Klauschie J, Wechter ME, Jacob K, Zanagnolo V, Montero R, Magrina J. et al. Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 2010; 17: 504-7
  • 17 Luginbuhl A, Schwartz DM, Sestokas AK, Cognetti D, Pribitkin E. Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy. Laryngoscope 2012; 122 (01) 10-5
  • 18 Karna ST, Pandey CK, Pandey VK, Singh A. Brachial plexus injury in live related donor hepatectomy: A chart review. J Postgrad Med 2014; 60: 287-9
  • 19 Thatte MR. Monitoring to prevent brachial plexus injury. J Postgrad Med 2014; 60: 241-2