Infraclavicular brachial plexus injury following axillary regional block

Abstract

Infraclavicular brachial plexopathy is a potential complication of axillary regional block. We retrospectively reviewed 13 such injuries and found the median nerve most often affected, followed by combined median and ulnar neuropathies, and then by various combinations involving the median, ulnar, radial, and musculocutaneous nerves. All were axon-loss in type and most were severe in degree electrophysiologically. The clinical and electrodiagnostic features of these injuries are strikingly similar to those sustained after axillary arteriography, which has been associated with the medial brachial fascial compartment (MBFC) syndrome. This syndrome is characterized by the evolution of neurologic deficits and pain following hematoma formation within a compartment of the upper arm. Thus, we believe that this mechanism underlies most nerve injuries that result from axillary angiography or axillary regional block. This has important treatment implications, as timely surgical intervention may lead to improved outcome.

Hématome axillaire sur introducteur causant des complications neurologiques après accès artériel

“…Distal pulses are often preserved because the increased intra-compartmental pressure can compress nerve microcirculation without affecting arterial blood flow. 8 Distal circulation is also protected by the extensive collateral circulation to the hand. Patients discharged from the hospital after an arteriographic study should be warned of the possibility of these delayed symptoms considering the preserved blood flow.…”

Median Nerve Injury Caused by Brachial Plexus Block for Carpal Tunnel Release Surgery

“…However, peripheral nervous system injuries can occur through the followings: 1) direct needle trauma, 2) intraneural anesthetic injection, and 3) axillary arterial laceration. In addition, infraclavicular brachial plexus injury was reported in 0.2%-21% of the cases [4,5]. Tsao and Wilbourn [5] reported that the median nerve was most commonly affected, followed by the combined median and ulnar neuropathies in 13 cases, with brachial plexus injury after axillary BPB.…”

“…In addition, infraclavicular brachial plexus injury was reported in 0.2%-21% of the cases [4,5]. Tsao and Wilbourn [5] reported that the median nerve was most commonly affected, followed by the combined median and ulnar neuropathies in 13 cases, with brachial plexus injury after axillary BPB. In their study, medial brachial fascial compartment (MBFC) syndrome was suggested as one of the causes of median nerve injury.…”

Comparison of the Transarterial Axillary Block and the Ultrasound-Guided Infraclavicular Block for Upper Extremity Surgery

“…19,20 This may explain why subjects in the transarterial axillary group had significantly more pain and tenderness at the site of injection when compared with the subjects in the infraclavicular block group. Our results are comparable to those of Urban and Urquhart, 1 who found that 23% of subjects receiving a transarterial axillary block complained of pain or tenderness on the first postoperative day.…”