Intraoperative brachial plexus injury during emergence following movement with arms restrained: a preventable complication?

Mark H Chandler¹ , Laura DiMatteo² , Erik A Hasenboehler³ and Michael Temple¹

¹Department of Anesthesiology, Denver Health Medical Center, 777 Bannock Street, Denver, CO, 80204-4507, USA

²Department of Orthopedics, niversity of Colorado Health Sciences Center, 2631 East 17th Avenue, Academic Office1, Room 4602, Aurora, CO, 80045, USA

³Department of Orthopedics, Spital Oberengadin, Chirurgische Abteilung, 7503 Samedan, Switzerland

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Patient Safety in Surgery 2007, 1:8doi:10.1186/1754-9493-1-8


Published:	19 December 2007

Abstract

Background

Despite considerable analysis and preventive strategies, brachial plexus injuries remain fairly common in the perioperative setting. These injuries range from brief periods of numbness or discomfort in the immediate postoperative period to, in rare cases, profound, prolonged losses of sensation and function. We present a case of an orthopedic surgery patient who suffered a brachial plexus injury while under anesthesia after trying to sit upright with his arms restrained.

Case presentation

After the uneventful placement of an intramedullary tibial nail, an 18 year old patient tried to sit upright with his arms restrained while still under the influence of anesthesia. In the immediate postoperative period, the patient complained of a profound loss of sensation in his left arm and an inability to flex his left elbow, suppinate his arm, or abduct and rotate his shoulder. Neurological examination and subsequent studies revealed a C5-6 brachial plexus injury. The patient underwent range of motion physical therapy and, over the next three months, regained the full function and sensation of his left arm.

Conclusion

Restraining arms during general anesthesia to prevent injury remains a wise practice. However, to avoid injuring the brachial plexus while the arms are restrained, extra caution must be used to prevent unexpected patient movement and to ensure gentle emergence.