Brachial plexus block improved refractory pain due to intraoperative position-related nerve injury: a case report

Abstract

Background: Peripheral nerve injury is a significant perioperative complication. We report a case of a patient with intraoperative position-related brachial plexus injury, whose symptoms were improved by brachial plexus block. Case: A 23-year-old man underwent thoracoscopic resection for an anterior mediastinal tumor. The surgery lasted 8 hours under the right prone position with his left arm fixed at the shoulder height, and his neck-slightly extended. Immediately after the surgery, the patient complained of severe pain, with paralysis and numbness of the left upper extremity. Magnetic resonance neurography revealed a swollen brachial plexus. He was referred to our pain clinic because his symptoms did not improve with conservative treatment. We decided to perform ultrasound-guided branchial plexus block (1％ mepivacaine＋dexamethasone [3.3 mg]) to control pain and inflammation. After five blocks, although numbness remained, his pain improved considerably. Conclusion: The brachial plexus block could ameliorate acute neuropathic pain with inflammation.