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Brachial Plexus Neuropraxia in Immediate Postoperative Period After Unilateral Total Mastectomy in a Hospital in Southern Huila: Case Report

Received: 17 September 2021    Accepted: 26 October 2021    Published: 30 October 2021
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Abstract

Gynecomastia is a pathology in which there is an increase of the mammary gland in men, its etiology is varied and imprecise, the incidence ranges between 32 to 36%, the diagnosis is based on anamnesis and physical examination directed to define if it is physiological or requires medical intervention, the therapeutic conduct of choice is surgical treatment consisting of bilateral or unilateral mastectomy as the case may be, like other surgical interventions, breast surgery can give rise to neurological lesions evidenced in the immediate postoperative period, most of which are not related to the surgical act but to the position of the patient during the procedure. Neurological lesions of peripheral nerves refer to a transient dysfunction without structural damage until the permanent loss of the integrity of the peripheral nerve. In relation to the present case the lesions specifically of the brachial plexus correspond to 2⁄3 of the lesions produced during the perioperative period affecting the sensory and motor innervation for the entire upper limb since it is constituted by the communications that are established between the anterior branches of the spinal nerves; It is a rare event with an incidence that corresponds to less than 1%, it is a phenomenon difficult to identify and prevent due to its multifactorial etiology, however, mechanical factors related to the patient's position during the procedure such as hyperabduction of the upper limb or hyperextension in external rotation of the upper limb are associated as the main risk factors. Its exact incidence is unknown because most of the published cases do not show neurological lesions, thus motivating the report of the present case.

Published in International Journal of Anesthesia and Clinical Medicine (Volume 9, Issue 2)
DOI 10.11648/j.ijacm.20210902.14
Page(s) 38-40
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Brachial Plexus, Peripheral Nerve Injuries, Brachial Plexus Neuropathies

References
[1] López, S., 2015. ARYDOL - Anatomía del plexo braquial.
[2] Calderón W., Israel G., Bassa S, J., Kauak K, L., OLGUÍN M, F., OLGUÍN M, R. et al., 2008. Ginecomastia y pseudoginecomastia. Tratamiento. Rev. Chilena de Cirugía. Vol 61 – N°2, Abril 2009; pag 131-135.
[3] Jaramillo H., Gomez L., Duque J., Tecnología en salas de cirugía y neuropraxia del plexo braquial. Revista Colombia Anestesia. Mayo-julio 2010 Vol 38 N°2: 260-267.
[4] Chui Janson; Murkin John M.; Posner Karen L.; Domino Karen B.; Perioperative Peripheral Nerve Injury After General Anesthesia: A Qualitive Systematic Review. Anesthesia & Analgesia: July 2018 – Volume 127 – Issue 1 – p 134-143.
[5] Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies 2018: An Update Report by the American Society of Anesthesiologist Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology. January 2018, Vol. 128, 11-26.
[6] Larson SJ, Incidence of position related neuropraxia in 4489 consecutive patients undergoing spine surgery. Role of SSEP monitoring? J Neurosurg. 2016; 124: A1146–A1209.
[7] Johnson RL, Warner ME, Staff NP, Warner MA, Neuropathies after surgery: Anatomical considerations of pathologic mechanisms. Clin Anat. 2015; 28: 678–682.
[8] Sondekoppam RV, Tsui BC, Factors associated with risk of neurologic complications after peripheral nerve blocks: a systematic review. Anesth Analg. 2017; 124: 645–660.
[9] Kamel I, Zhao H, Koch SA, Brister N, Barnette RE, The use of somatosensory evoked potentials to determine the relationship between intraoperative arterial blood pressure and intraoperative upper extremity position-related neurapraxia in the prone surrender position during spine surgery: a retrospective analysis. Anesth Analg. 2016; 122: 1423–1433.
[10] Morizot-Koutlidis R, André-Obadia N, Antoine JC, et al., Somatosensory evoked potentials in the assessment of peripheral neuropathies: commented results of a survey among French-speaking practitioners and recommendations for practice. Neurophysiol Clin. 2015; 45: 131–142.
[11] Devic P, Petiot P, Mauguiere F, Diagnostic utility of somatosensory evoked potentials in chronic polyradiculopathy without electrodiagnostic signs of peripheral demyelination. Muscle Nerve. 2016; 53: 78–83.
[12] Alcantara SD, Wuamett JC, Lantis JC 2nd, et al. Outcomes of combined somatosensory evoked potential, motor evoked potential, and electroencephalography monitoring during carotid endarterectomy. Ann Vasc Surg. 2014; 28: 665–672.
[13] Silverstein JW, Madhok R, Frendo CD, DeWal H, Lee GRContemporaneous evaluation of intraoperative ulnar and median nerve somatosensory evoked potentials for patient positioning: a review of four cases. Neurodiagn J. 2016; 56: 67–82.
[14] Blackburn A, Taghizadeh R, Hughes D, O’Donoghue JM: Prevention of perioperative limb neuropathies in abdominal free flap breast reconstruction. J Plast Reconstr Aesthet Surg 2016; 69: 48–54.
[15] O’Brien S, Bennett D, Spence DJ, Mawhinney I, Beverland DE: Contralateral ulnar neuropathy following total hip replacement and intraoperative positioning. Int J Orthop Trauma Nurs 2016; 21: 31–8.
Cite This Article
  • APA Style

    Mario German Orozco Sandoval, Felipe Andres Beltran Torres, Laura Cristina Fandiño, Nellyth Julieth España Tobar, Stefany Mejía Buesaquillo, et al. (2021). Brachial Plexus Neuropraxia in Immediate Postoperative Period After Unilateral Total Mastectomy in a Hospital in Southern Huila: Case Report. International Journal of Anesthesia and Clinical Medicine, 9(2), 38-40. https://doi.org/10.11648/j.ijacm.20210902.14

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    ACS Style

    Mario German Orozco Sandoval; Felipe Andres Beltran Torres; Laura Cristina Fandiño; Nellyth Julieth España Tobar; Stefany Mejía Buesaquillo, et al. Brachial Plexus Neuropraxia in Immediate Postoperative Period After Unilateral Total Mastectomy in a Hospital in Southern Huila: Case Report. Int. J. Anesth. Clin. Med. 2021, 9(2), 38-40. doi: 10.11648/j.ijacm.20210902.14

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    AMA Style

    Mario German Orozco Sandoval, Felipe Andres Beltran Torres, Laura Cristina Fandiño, Nellyth Julieth España Tobar, Stefany Mejía Buesaquillo, et al. Brachial Plexus Neuropraxia in Immediate Postoperative Period After Unilateral Total Mastectomy in a Hospital in Southern Huila: Case Report. Int J Anesth Clin Med. 2021;9(2):38-40. doi: 10.11648/j.ijacm.20210902.14

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  • @article{10.11648/j.ijacm.20210902.14,
      author = {Mario German Orozco Sandoval and Felipe Andres Beltran Torres and Laura Cristina Fandiño and Nellyth Julieth España Tobar and Stefany Mejía Buesaquillo and Xsara Camila Rodríguez Cerón and Alejandra Katherine Franco Torres},
      title = {Brachial Plexus Neuropraxia in Immediate Postoperative Period After Unilateral Total Mastectomy in a Hospital in Southern Huila: Case Report},
      journal = {International Journal of Anesthesia and Clinical Medicine},
      volume = {9},
      number = {2},
      pages = {38-40},
      doi = {10.11648/j.ijacm.20210902.14},
      url = {https://doi.org/10.11648/j.ijacm.20210902.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20210902.14},
      abstract = {Gynecomastia is a pathology in which there is an increase of the mammary gland in men, its etiology is varied and imprecise, the incidence ranges between 32 to 36%, the diagnosis is based on anamnesis and physical examination directed to define if it is physiological or requires medical intervention, the therapeutic conduct of choice is surgical treatment consisting of bilateral or unilateral mastectomy as the case may be, like other surgical interventions, breast surgery can give rise to neurological lesions evidenced in the immediate postoperative period, most of which are not related to the surgical act but to the position of the patient during the procedure. Neurological lesions of peripheral nerves refer to a transient dysfunction without structural damage until the permanent loss of the integrity of the peripheral nerve. In relation to the present case the lesions specifically of the brachial plexus correspond to 2⁄3 of the lesions produced during the perioperative period affecting the sensory and motor innervation for the entire upper limb since it is constituted by the communications that are established between the anterior branches of the spinal nerves; It is a rare event with an incidence that corresponds to less than 1%, it is a phenomenon difficult to identify and prevent due to its multifactorial etiology, however, mechanical factors related to the patient's position during the procedure such as hyperabduction of the upper limb or hyperextension in external rotation of the upper limb are associated as the main risk factors. Its exact incidence is unknown because most of the published cases do not show neurological lesions, thus motivating the report of the present case.},
     year = {2021}
    }
    

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    AU  - Mario German Orozco Sandoval
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    AU  - Xsara Camila Rodríguez Cerón
    AU  - Alejandra Katherine Franco Torres
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    JF  - International Journal of Anesthesia and Clinical Medicine
    JO  - International Journal of Anesthesia and Clinical Medicine
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    PB  - Science Publishing Group
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    AB  - Gynecomastia is a pathology in which there is an increase of the mammary gland in men, its etiology is varied and imprecise, the incidence ranges between 32 to 36%, the diagnosis is based on anamnesis and physical examination directed to define if it is physiological or requires medical intervention, the therapeutic conduct of choice is surgical treatment consisting of bilateral or unilateral mastectomy as the case may be, like other surgical interventions, breast surgery can give rise to neurological lesions evidenced in the immediate postoperative period, most of which are not related to the surgical act but to the position of the patient during the procedure. Neurological lesions of peripheral nerves refer to a transient dysfunction without structural damage until the permanent loss of the integrity of the peripheral nerve. In relation to the present case the lesions specifically of the brachial plexus correspond to 2⁄3 of the lesions produced during the perioperative period affecting the sensory and motor innervation for the entire upper limb since it is constituted by the communications that are established between the anterior branches of the spinal nerves; It is a rare event with an incidence that corresponds to less than 1%, it is a phenomenon difficult to identify and prevent due to its multifactorial etiology, however, mechanical factors related to the patient's position during the procedure such as hyperabduction of the upper limb or hyperextension in external rotation of the upper limb are associated as the main risk factors. Its exact incidence is unknown because most of the published cases do not show neurological lesions, thus motivating the report of the present case.
    VL  - 9
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Author Information
  • Department of Anesthesiology and General Surgery, San Antonio de Pitalito Hospital, Pitalito, Colombia

  • Department of Anesthesiology and General Surgery, San Antonio de Pitalito Hospital, Pitalito, Colombia

  • Department of Anesthesiology and General Surgery, San Antonio de Pitalito Hospital, Pitalito, Colombia

  • Department of Anesthesiology and General Surgery, San Antonio de Pitalito Hospital, Pitalito, Colombia

  • Department of Anesthesiology and General Surgery, San Antonio de Pitalito Hospital, Pitalito, Colombia

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