Compression of the brachial plexus during right lobe liver donation as a cause of brachial plexus injury: A case report

Dulitz, Michael G.; Wolf, André M. De; Wong, Hak Y.; Wray, Chris; Sherwani, Saadia S.; Herborn, Josh; Sufit, Robert; Koffron, Alan J.

doi:10.1002/lt.20343

Cited by 11 publications

(6 citation statements)

References 12 publications

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“…Even with careful positioning and regular monitoring, a wide range and severity of nerve involvement has been observed in clinical practice. Dulitz et al26 reported brachial plexus injury in a living related liver donor possibly due to compression of the plexus between the first rib and clavicle as the result of upward surgical retraction of the rib cage. Surgical complications were also observed, although their occurrence was somewhat less than has been reported 14, 27…”

Section: Discussionmentioning

confidence: 99%

Anesthesia care for adult live donor hepatectomy: Our experiences with 100 cases

et al. 2007

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A total of 100 patients who underwent elective lobar donor hepatectomy from 2000 to 2002 at the University of Rochester Medical Center were reviewed. Assessed clinical data were estimated blood loss, intraoperative central venous pressure (CVP), blood product and fluid administration, perioperative arterial blood gas tension and acid-base state, metabolic status, perioperative serum levels of aspartate aminotransferase, alanine aminotransferase, prothrombin time, albumin, and lactate, procedure duration, and perioperative complications. All patients survived surgery, and the average duration of surgery (from skin incision to skin closure) was 615 Ϯ 99.6 minutes. Mean blood loss was 549 Ϯ 391 mL (range, 80-2,500 mL), and only 4 patients required homologous blood transfusion. The intraoperative blood loss did not correlate with CVP values. A total of 72 patients received isotonic sodium bicarbonate solution, and their metabolic variables were superior to those of normal saline group patients (arterial pH, 7.35 Ϯ 0.03 vs. 7.29 Ϯ 0.07; base excess, -4.3 Ϯ 2.4 vs. 7.3 Ϯ 3.4; and serum bicarbonate level, 20.6 Ϯ 2.2 vs. 18.6 Ϯ 2.9). However, the better control of metabolic acidosis was not associated with serum lactate levels or other outcome measures. Maintaining the CVP Ͻ 5 mmHg was not associated with blood loss. Clinically significant anesthetic complications were severe metabolic acidosis, pneumothorax and respiratory insufficiency immediately following extubation in the operating room. In conclusion, placement of a thoracic epidural catheter delivering a local anesthetic in addition to intravenous (IV) patient-controlled analgesia with opiates provided safe and effective pain control in most patients. Further prospective studies should shed a light on the optimal care of patients undergoing liver donor hepatic resection. Liver Transpl 13: 537-542, 2007.

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Section: Discussionmentioning

confidence: 99%

Anesthesia care for adult live donor hepatectomy: Our experiences with 100 cases

et al. 2007

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“…It was suggested that these neuropathies were probably related to prolonged anesthesia, invasive central venous monitoring catheters, and surgical procedures such as venovenous bypass. Another case report noted brachial plexus injury caused by compression of the plexus between the fi rst rib and clavicle, resulting from rib cage retraction for surgical exposure [8].…”

Section: Discussionmentioning

confidence: 99%

Bilateral brachial plexus injury after liver transplantation

et al. 2008

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We report a case of bilateral brachial plexus injury following living-donor liver transplantation. A 35-year-old man with hepatitis C cirrhosis underwent liver transplantation under general anesthesia, performed in the supine position with 90 degrees arm abduction. The surgery lasted for 14 h, and the anesthesia for 16 h. On postoperative day 1, it was noticed that he had brachial plexus injuries. We investigated the cause of the nerve injuries, in particular, the possible involvement of stretching, compression, or nerve ischemia, which can often result from excessive abduction, the use of shoulder braces, compression by the poles used in the operating theater or compression caused by surgeons leaning on the patient, or serious general status (e.g., hypotension or hypoxemia). Our findings were inconclusive, but we postulated that 90 degrees abduction of the arms per se may have resulted in excessive stretching of the brachial nerves, causing his injuries.

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“…12,13 To achieve adequate surgical exposure during liver surgery, metal retractors that pull the rib cage in an anterior and cephalad direction are frequently used. 3 In this study, the extent of retraction was routinely monitored by using the loss or dampening of a right radial arterial waveline pressure tracing as a surrogate of compression of the neurovascular bundle between the clavicle and first rib because of retractor use. Interestingly, we found that 82% of neuropathies were left sided, suggesting that attention should also be placed toward the leftward pull of retractors for exposure.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Operative factors unique to major liver surgery may place these patients at particularly increased risk of peripheral nerve injury, such as the routine use of large bore venous catheters, veno-veno bypass, lengthy operative times, potential for significant intraoperative hypotension, and retractors that cause the cephalad displacement of the rib cage toward the clavicle thus compressing the brachial plexus. 3 Although anecdotally described, the incidence of peripheral nerve injury in liver transplantation has not been well investigated. Perhaps, the largest series is in the living donor liver population, the Adult-to-Adult Living Donor Liver Transplantation or A2ALL cohort, in which neuropraxia is reported in 3%-4% of living donors, taking up to 3 y to resolve, and resulting in permanent work disability in some.…”

Section: Introductionmentioning

confidence: 99%

Neuropraxia: An Underappreciated Morbidity of Liver Transplantation

Craig‐Schapiro

Krepostman

Ravi

et al. 2020

Journal of Surgical Research

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Compression of the brachial plexus during right lobe liver donation as a cause of brachial plexus injury: A case report

Abstract: We present a case of brachial plexus injury in a living-related liver donor, most likely caused by compression of the plexus between the 1st rib and clavicle, the result of rib retraction for surgical exposure.

Cited by 11 publications

References 12 publications

Anesthesia care for adult live donor hepatectomy: Our experiences with 100 cases

Anesthesia care for adult live donor hepatectomy: Our experiences with 100 cases

Bilateral brachial plexus injury after liver transplantation

Neuropraxia: An Underappreciated Morbidity of Liver Transplantation

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