Abstract
Objectives To describe the successful treatment for iatrogenic superficial cervical plexus neuropathy following brachial plexus block, which is a rare complication of this procedure. Case Report We present a case report of a 67-year-old male who underwent a surgical excision of gouty tophi of the thumb and index finger with brachial plexus block for postoperative pain control. He had no prior history of chronic headaches or facial neuropathic pain. Thirty-six hours following surgery the patient experienced burning pain in his occiput, jaw, ear, and proximal shoulder. The patient was diagnosed with iatrogenic superficial cervical plexus neuropathy, which proved refractory to oral methylprednisolone and neuropathic medications. A superficial cervical plexus injection with bupivacaine and dexamethasone resulted in an 80% resolution of pain for over 6 months. Conclusion Superficial cervical plexus injury may occur following interscalene brachial plexus nerve block. Superficial cervical plexus block may provide early effective treatment for neuropathy refractory to conservative measures.
Highlights
The brachial plexus block is widely used for patients undergoing shoulder and upper extremity surgery
To describe the successful treatment for iatrogenic superficial cervical plexus neuropathy following brachial plexus block, which is a rare complication of this procedure
Case Report We present a case report of a 67-year-old male who underwent a surgical excision of gouty tophi of the thumb and index finger with brachial plexus block for postoperative pain control
Summary
The brachial plexus block is widely used for patients undergoing shoulder and upper extremity surgery. The cervical plexus block is traditionally used for head and neck surgeries and is most commonly used for carotid endarterectomies.[6] The superficial branches of the cervical plexus originate from C2-C4 and form the lesser occipital, great auricular, transverse cervical, and supraclavicular sensory branches. These branches initially run deep to the prevertebral fascia in a groove between the longus capitis and the middle scalene muscles but not in the interscalene groove. Blocking the superficial plexus nerves allow for analgesia in certain surgeries such as thyroidectomies and has even been effective as the sole anesthetic modality for external ear surgery.[7]
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