Korean J Anesthesiol.  1993 Dec;26(6):1306-1310. 10.4097/kjae.1993.26.6.1306.

A Case Report of Brachial Plexus Palsy after Laparascopy Assisted Vaginal Hysterectomy

• Kim SB
• Lim HJ
• Kong MH
• Chae BK
• Chang SH

• KMID: 1933971
• DOI: http://doi.org/10.4097/kjae.1993.26.6.1306

Abstract

Trendelenburg position has been used for the low abdominal and pelvic surgery or for the management of the hypotensive patients. But, various adverse effects can also occur in steep Trendelenburg position, of which brachial plexus injury has been known as the most common nerve injury during this position under the general anesthesia especiaUy when the shoulder braces are used. We experienced a case of brachial plexus palsy in a 53 year old woman who had a laparas-copy assisted vaginal hysterectomy(LAVH) under the general anesthesia for myoma uteri for four and a half hours. During the operation she was in a 30 degree-tilting Trendelenburg and combined lithotomy position with her arms tucked at her side with drawsheet and shoulder braces were placed over the acromioclavicular joints bilaterally. In the morning of the postoperative 1st day, she complained the right shouder pain and the right arm tingling sensation and weakness. After needle electromyography and nerve conduction study, it was decided that she got an intraoperative brachial plexus injury mainly involving the lateral cord of the brachial plexus, resulting from the nerve compression caused by shoulder braces in Trendelenburg position. The symptoms were improved after the physical therapy and she was recommended to take more physical therapy after discharge.

Keyword

Trendelenburg Position; Brachial Plexus Palsy; Laparascopy Assisted Vaginal Hysterectomy

MeSH Terms

Acromioclavicular Joint
Anesthesia, General
Arm
Braces
Brachial Plexus*
Electromyography
Female
Head-Down Tilt
Humans
Hysterectomy, Vaginal*
Middle Aged
Myoma
Needles
Neural Conduction
Paralysis*
Sensation
Shoulder
Uterus