• The Korean Journal of Pain
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• v.24 no.3
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• pp.158-163
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• 2011

Background: Although a brachial plexus block can be used to provide anesthesia and analgesia for upper extremity surgery, its effects using $MgSO_4$ on postoperative pain management have not been reported. The aim of this study was to evaluate brachial plexus block using $MgSO_4$ on postoperative analgesia. Methods: Thirty-eight patients who were scheduled to undergo upper extremity surgery were randomly allocated into two groups: patients receiving axillary brachial plexus block with 0.2% ropivacaine 20 ml and normal saline 2 ml (group S) or 0.2% ropivacaine 20 ml and $MgSO_4$ 200 mg (group M). Before extubation, the blocks were done and patient controlled analgesia was started, and then, the patients were transported to a postanesthetic care unit. The postoperative visual analogue scale (VAS), opioid consumption, and side effects were recorded. Results: The two groups were similar regarding the demographic variables and the duration of the surgery. No differences in VAS scores were observed between the two groups. There was no statistically significant difference in opioid consumption between the two groups. Nausea was observed in three patients for each group. Conclusions: Axillary brachial plexus block using $MgSO_4$ did not reduce the level of postoperative pain and opioid consumption.

• Archives of Reconstructive Microsurgery
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• v.7 no.1
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• pp.35-40
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• 1998

The incidence of brachial plexus injury is increasing because of the development of motor vehicle but the the results of treatment was reported poor due to its complex anatomical structure and changes of function and sensory during the recovery after trauma. But the results of treatment has been improved by the recently introduced high sensitive diagnostic method that can evaluate accurately the site and extent of the injury and treatment method. Restoration of the elbow flexion is the most important goal of treatment after brachial plexus injury and nerve graft, neurotization and muscle transfer were used for methods of treatment. From December 1992 to May 1994, the author performed 6 cases of latissimus dorsi transfer at the same side for the improvement of elbow flexion in the patients of brachial plexus injury. There were 5 cases of male, one case of female and average age was 22 years old. The causes of injury were traffic accident in 3 cases, gun shot injury, falldown and birth injury in each one case and in all cases, the type of injury were upper arm type. The average follow up period were 1 year 5 months ranging from 12 months to 4 years 5 months. In all cases, active elbow flexion was impossible before operation and average muscle power was grade I. We analysed the active range of motion, muscle power and the functional results. At the last follow up, range of active elbow flexion was average $124^{\circ}$ and flexion contracture was average 11 degrees and the average of muscle power was grade IV. In the functional analysis, there were two cases of excellent, three cases of good and 1 case of fair. There was no complications including wound infection, vascular compromise and donor site problem. The results of latissimus dorsi transfer for improvement elbow flexion in the patients of brachial plexus injury is one of the useful mettled for the restoration of elbow flexion.

• Journal of the Korean Society of Radiology
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• v.8 no.5
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• pp.271-278
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• 2014

The purpose of this study is to know optimized fat suppression techniques for brachial plexus compared with STIR and SPAIR T1, T2 techniques. A total of 30 normal volunteers without brachial plexus disease were studied on a 3.0 T MRI scanner. As an analytical method, SNR, CNR, 4-point grading scale were evaluated by using three pulse sequences. As a quantitative analysis, the SNR, CNR for SPAIR T1 technique provided high value in branchial plexus roots (03.07, -2.25), branchial plexus trunks(06.70, 36.31)(p<0.05). As a qualitative Analysis, The visibility for delineation of brachial plexus, fat suppression, artifact was significantly better on SPAIR T1(3.2, 3.6, 3.4) technique(p<0.05).

• Annals of Clinical Neurophysiology
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• v.10 no.1
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• pp.43-47
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• 2008

Background: Acute brachial plexitis is an acute idiopathic inflammatory disease affecting brachial plexus, which is characterized by initial severe pain in shoulder followed by profound weakness of affected arm. This is a retrospective study to evaluate the clinical and electrophysiological profile of acute brachial plexitis. Methods: Sixteen patients with acute brachial plexitis were sampled. The electrodiagnostic studies included motor and sensory nerve conduction studies (NCSs) of the median and ulnar, sensory NCSs of medial and lateral antebrachial cutaneous nerves, and needle electromyography (EMG) of selected muscles of upper extremities and cervical paraspinal muscles. The studies were performed on both sides irrespective of the clinical involvement. Results: In most of our patient, upper trunk was predominantly affected (14 patients, 87.50%). Only two patients showed either predominant lower trunk affection or diffuse affection of brachial plexus. All had an acute pain followed by the development of muscle weakness of shoulder girdle after a variable interval ($7{\pm}8.95$ days). Ten patients (62.50%) had severe disability. In NCSs, the most frequent abnormality was abnormal lateral antebrachial cutaneous sensory nerve action potentials (SNAPs). On needle EMG, all the patients showed abnormal EMG findings in affected muscles. Conclusions: In this study, pain was the presenting feature in all patients, and the territory innervated by upper trunk of the brachial plexus was most frequently involved. The most common NCS abnormality was abnormal SNAP in lateral antebrachial cutaneous nerve. Our findings support that the electrodiagnostic test is useful in localizing the trunk involvement in acute brachial plexitis.

• Archives of Plastic Surgery
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• v.46 no.6
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• pp.594-598
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• 2019

Overall complication rates of 9.1% have been reported following implantable cardioverter defibrillator (ICD) placement. Brachial plexus injury is infrequently reported in the literature. We describe a 26-year-old female experiencing left arm nerve pain, a positive Tinel's sign, numbness in the median nerve distribution of the hand and biceps muscle weakness following revision ICD via subclavian vein approach. Nerve conduction studies identified severe partial left brachial plexopathy, which remained incompletely resolved with conservative management. Surgical exploration revealed lateral cord impingement by the ICD generator and a loop of the ICD lead, along with fibrosis, necessitating surgical neurolysis and ICD generator repositioning. As increasing numbers of patients undergo cardiac device implantation, it is incumbent on practitioners to be aware of potential increases in the prevalence of this complication.

• Archives of Reconstructive Microsurgery
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• v.19 no.1
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• pp.1-6
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• 2010

Schwannoma of the brachial plexus region is very rare. There has not been general agreement in terms of surgical outcome from limited number of studies. We analyzed surgical outcomes from 11 cases of schwannomas which occurred in the brachial plexus. From February 2000 to August 2009, 11 patients with schwannomas of the brachial plexus region were surgically treated by a single surgeon. We retrospectively reviewed the medical records and MRI of our cases, and evaluated the neurologic deficit and the recurrence of tumors after surgery. All the cases were proven histologically as schwannomas. The mean age of the patients was 52.6(36~67) years old, 4 of them were male and 7 were female. The tumor was located in the left side in 9 patients, and right in 2. The mean postoperative follow-up was 24.7(6~78) months. Initial presentation was usually painless, palpable mass. The mass was located in various level of the brachial plexus such as root, trunk, cord, or terminal branch level. The size of mass was from $1.5{\times}1.5{\times}0.5$ cm to $11.0{\times}10.0{\times}6.0$ cm. Eight of 11 patients showed no neurologic deficit. Three patients showed postoperative neurologic deficit; two of them had transient sensory deficit, and one of them had weakness of flexor pollicis longus and 2nd flexor digitorum profundus. There were no recurrences. The schwannoma of the brachial plexus region should be considered as a curable lesion with an acceptable surgical risk of injury to neurovascular structures. With precise surgical techniques, these tumors can be removed to improve patient's symptoms with minimal morbidity.

• Journal of Acupuncture Research
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• v.30 no.5
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• pp.219-226
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• 2013

Objectives : The purpose of this study is to report the effect of Korean medicine treatment on a patient with brachial plexus injury. Methods : The patient with symptoms of pain and dysesthesia on right forearm and hand was treated with acupuncture treatment, herbal medicine, moxibustion and physical treatment. Improvement of the patient's symptoms was evaluated by Hepatic dullness sound, NRS, VAS, SF-36 bodily pain, grip strength. Results : After 42 days of treatment, NRS score significantly decreased. VAS score, SF-36 bodily pain and grip strength showed moderate improvement. Conclusions : This results suggest that Korean medicine treatment may be effective in reducing the symptoms of brachial plexus injury.

• Archives of Reconstructive Microsurgery
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• v.10 no.1
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• pp.7-11
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• 2001

Purpose : To evaluate the neurologic abnormalities in the donor limb after contralateral C7 transfer in brachial plexus injury. Materials and Methods : From August 1996 to December 1999, five patients with brachial plexus injury were treated with contralateral C7 nerve root transfer. The average follow up was 16 months(range, 5 to 36 months). The clinical findings were assessed using the British Medical Research Council Grading System, and also measured grip power, pinch power of hand and two point discrimination of the fingers. Results : We had no difference in shoulder abduction and elbow flexion after contralateral C7 transfer. The grip and pinch strength were recovered within 4weeks. Sensory loss occurred in all patients and was noted to be more severe on index and middle finger. Four patients recovered within 2 weeks, one continued till one year. Subjective numbness and pain on percussion minimally persisted until last follow-up. Conclusion : The division of the C7 nerve root resulted in minimal and temporary functional deficit in the donor upper limb.

• The Korean Journal of Pain
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• v.14 no.1
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• pp.41-45
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• 2001

Background: Clonidine, a selective ${\alpha}_2$ adrenergic agonist, increases the duration of anesthesia and analgesia when it is used with local anesthetics. This study was undertaken to evaluate whether clonidine, which was mixed with lidocaine for the brachial plexus block (BPB), has a local (peripheral) or a systemic (central) anesthetic effect. Methods: Seventy patients scheduled for upper extremity surgery were randomly allocated to two groups. In group IV (n = 35) an axillary perivascular BPB was performed with 40 ml of 1% lidocaine and 1：200,000 epinephrine, and just after BPB clonidine $2{\mu}g/kg$ was administered intravenously. In group BPB (n = 35) the same BPB was performed with 40 ml of 1% lidocaine, 1：200,000 epinephrine and clonidine $2{\mu}g/kg$. The following variables were recorded: onset time, duration of anesthesia and analgesia, and adverse effects. Results: Onset time was comparable in both groups. The duration of anesthesia and analgesia significantly increased to 306 min and 354 min in group BPB, when compared to 119 min and 151 min in group IV, respectively. No side effects such as hypotension, bradycardia, and sedation were reported. Conclusions: The duration of anesthesia and analgesia is prolonged by adding clonidine to lidocaine during brachial plexus block, which suggests that its effect is local rather than systemic.

• The Korean Journal of Pain
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• v.26 no.4
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• pp.401-405
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• 2013

Complex regional pain syndrome secondary to brachial plexus injury is often severe, debilitating and difficult to manage. Percuteneous radiofrequency sympathectomy is a relatively new technique, which has shown promising results in various chronic pain disorders. We present four consecutive patients with complex regional pain syndrome secondary to brachial plexus injury for more than 6 months duration, who had undergone percutaneous T2 and T3 radiofrequency sympathectomy after a diagnostic block. All four patients experienced minimal pain relief with conservative treatment and stellate ganglion blockade. An acceptable 6 month pain relief was achieved in all 4 patients where pain score remained less than 50% than that of initial score and all oral analgesics were able to be tapered down. There were no complications attributed to this procedure were reported. From this case series, percutaneous T2 and T3 radiofrequency sympathectomy might play a significant role in multi-modal approach of CRPS management.