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Injury to the Brachial and the Cervical Plexuses Following Interscalene Brachial Plexus Block Are Independent Risks: Presented at ASA By Lexa W. Lee NEW ORLEANS -- October 18, 2009 -- Injury to the brachial plexus after interscalene brachial plexus block (ISB) does not significantly coincide with injury to the cervical plexus. These complications appear to be different and independent of each other, although they may be caused by similar mechanisms, according to results of a new study presented at the 2009 Annual Meeting of the American Society of Anesthesologists (ASA). ISB is often used to manage pain during and after shoulder surgery. Adverse neurological effects from ISB are generally low, although injury to the brachial as well as the cervical plexus have been reported, stated lead investigator Saskia Christ, MD, anaesthesiologist, Munich-Bogenhausen Hospital, Munich, Germany, speaking here on October 17. The researchers wanted to investigate whether the 2 complications are independent of each other after single-injection ISB following shoulder surgery. The prospective study analysed 273 patients. Pre-existing neurological conditions were excluded. A single-injection ISB consisting of 10 mL bupivacaine 0.5% + 30 mL bupivacaine 0.25% was administered. After 24 hours, the subjects were screened for neurological complications. They were subsequently phoned 31 days later and asked about the occurrence of symptoms related to brachial and/or cervical plexus injury. Symptomatic patients were followed up again after 6 months. Fisher’s exact test was used for statistical analysis. On the first day following surgery, 36 (13.2%) patients reported ISB-related affection of the brachial and/or the cervical plexus; 20 (7.3%) reported symptoms consistent with affection of the brachial plexus. Affection of both the cervical and the brachial plexus was found in 5 (1.8%) patients, although that coincidence was not statistically significant. After 31 days, 15 patients (5.5%) remained symptomatic. Affection of the brachial plexus was detected in 12 patients (4.4%). Neuropathy of both the cervical plexus and brachial plexus were found in 2 (0.7%), although that coincidence, again, was not statistically significant. At 6 months, 4 (1.5%) patients showed symptoms of the brachial plexus that were considered ISB-related. Injury to the brachial plexus, the researchers concluded, does not significantly coincide with injury to the cervical plexus after ISB. The 2 injuries appear to be independent of each other. [Presentation title: Injury to the Brachial and the Cervical Plexus Are Independent Risks of Shoulder Surgery With ISB. Abstract A167] E-mail this page to a friend or colleague! To print, use this version