Anästhesie und klinische Forschung
Offener Zugang
ISSN: 2155-6148
ISSN: 2155-6148
R.K. Gautam, A.K. Paswan, Shashi Prakash, N. Verma
Objective: To report a case of 4 month old Brachial plexus injury leading to Axillary nerve and Musculocutaneous nerve axonal involvement, improved post Stellate ganglion block and hydro-dissection.
Summary of background: Trauma leading to physical work limitation especially of upper limb can be extremely worrisome in individual, most importantly if he is the sole bearer of a family. This case presented by us, will clearly depict that if an appropriate diagnostic setting and step-wise approach is used, the Brachial Plexus injury leading to CRPS-II can be improved with better outcome in the physical functioning of the affected limb.
Case: A 55-year-old patient presented to the Pain management department with complains of pain in Left arm, forearm, and hand with paresis. This started after an event of fall from a running bike about 4 months back. The power in his shoulder was 2/5, Elbow 1/5 and wrist 1/5. He also complained of severe paroxysmal pain of sharp, stabbing character in his entire arm majorly on lateral side with a continuous dull deep aching pain. He was having loss of hair on his hand with swelling mostly on the wrist’s dorsum aspect. CRPS 2 was provisionally thought and was taken for SGB block, which improved his pain and sudomotor signs.
In the next sitting, Hydro-dissection was performed in the injured Brachial plexus site with 0.9% normal saline at the trunk and division level which led to improvement in his power over a period of 1 month time.
Conclusion: A prompt diagnosis of CRPS-2 with appropriate sympathetic block can help in preventing the further progress. Also, even after 4 months of the injury, an apt hydro-dissection to relieve the post traumatic fibrosis can improve the nerve conduction and can eventually save the limb.