Case scenario: postoperative brachial plexopathy associated with infraclavicular brachial plexus blockade: localizing postoperative nerve injury.

Abstract

POSTOPERATIVE nerve injuries (PNIs) have anesthetic, patient, and surgical contributions and determining the etiology may be challenging when peripheral nerve blockade is used. Evaluating PNI relies on clinical assessment, electrodiagnostic testing, and magnetic resonance imaging (MRI). MRI of peripheral nerves can diagnose external compression or loss of nerve continuity and is increasingly used for evaluation of peripheral nerve disease.1 Determining the etiology of PNI requires an injury to be definitively localized and whether it is concordant with the peripheral nerve blockade site or distinct from it. We present a case of postoperative brachial plexopathy after microvascular toe segment transfer surgery where continuous infraclavicular blockade was used. The objective of this case scenario is to explore the challenges in precisely localizing PNI and the roles and limitations of electrodiagnostic testing and MRI.