Iatrogenic Brachial Plexopathy due to Improper Positioning during Radiofrequency Ablation

ABSTRACT

Iatrogenic peripheral nerve injuries are a common source of postprocedural morbidity. The authors present a case report of a patient who developed brachial plexopathy from positioning during radiofrequency ablation of a renal mass. Though incidence data on the majority of iatrogenic peripheral nerve injury is scarce, there is more concrete data on iatrogenic brachial plexopathy. The incidence of brachial plexopathies is ~0.2% of all patients who receive general anesthesia, with between 7 and 10% of brachial plexopathies being iatrogenic in nature. The mechanism of injury in the majority of cases is due to stretching or compression of the nerve tissue. Treatment is largely supportive. Prevention is key in minimizing this form of patient morbidity. It is the operator's responsibility to mitigate this risk by employing proper positioning techniques and communicating closely with the anesthesia staff when applicable.

KEYWORDS

Brachial plexus - plexopathy - peripheral nerve injury - iatrogenic

REFERENCES

• 1 Birch R, Bonney G, Dowell J, Hollingdale J. Iatrogenic injuries of peripheral nerves.  J Bone Joint Surg Br. 1991;  73 (2) 280-282
• 2 Kline D G, Judice D J. Operative management of selected brachial plexus lesions.  J Neurosurg. 1983;  58 (5) 631-649
• 3 Narakas A O. The surgical treatment of traumatic brachial plexus lesions.  Int Surg. 1980;  65 (6) 521-527
• 4 Lederman R J, Breuer A C, Hanson M R et al.. Peripheral nervous system complications of coronary artery bypass graft surgery.  Ann Neurol. 1982;  12 (3) 297-301
• 5 Posta Jr A G, Allen A A, Nercessian O A. Neurologic injury in the upper extremity after total hip arthroplasty.  Clin Orthop Relat Res. 1997;  345 (345) 181-186
• 6 Dawson D M, Krarup C. Perioperative nerve lesions.  Arch Neurol. 1989;  46 (12) 1355-1360
• 7 Wilbourn A J. Iatrogenic nerve injuries.  Neurol Clin. 1998;  16 (1) 55-82
• 8 Winfree C J, Kline D G. Intraoperative positioning nerve injuries.  Surg Neurol. 2005;  63 (1) 5-18, discussion 18
• 9 Wilbourn A J. Brachial plexus disorders. In: Dyck P J, Thomas P K, eds. Peripheral Neuropathy. 3rd ed. Philadelphia: WB Saunders; 1993: 911-950
• 10 Cooper D E, Jenkins R S, Bready L, Rockwood Jr C A. The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery.  Clin Orthop Relat Res. 1988;  288 (228) 33-41