Brachial Plexus Nerve Research Articles

Experience of using the passive exoskeleton EXAR-34 in complex rehabilitation of a patient with post-traumatic plexopathy due to gunshot cervicothoracic wound (clinical observation)

The use of passive exoskeletons is a promising direction in the treatment of patients with severe combat injuries to the shoulder girdle, leading to disability in 30 % of cases. Aim: To demonstrate the capabilities of the passive exoskeleton EXAR-34 in the rehabilitation and habilitation of a victim with damage to the branches of the brachial nerve plexus. Materials and methods: An analysis of medical documentation, physical examination, morphometry, and goniometry were carried out. Clinical observation and discussion: A patient with post-traumatic left-sided plexopathy due to a gunshot perforating shrapnel cervicothoracic wound with gunshot fractures of the transverse processes of C6, C7, Th3 vertebrae, I–III ribs on the left after reconstructive intervention on elements of the brachial nerve plexus, when previously carried out rehabilitation measures were ineffective, during the first fitting of the EXAR-34 device, the range of active movements in the joints of the injured limb increased to 37,1–60,7 %, and routine motor skills were restored. Conclusion:The experience of using the EXAR-34 device demonstrates high promise in complex rehabilitation and habilitation of patients after reconstructive interventions on the brachial plexus for combat wounds.

Diagnostic Capability of Ultrasonography in Evaluating Peripheral Nerve Injuries of the Brachial Plexus.

The purpose of this study is to determine the diagnostic capability of ultrasonography (US) in patients with suspected brachial plexus injury (BPI) to the terminal nerves by comparing physical examination (PE) findings with US, electromyography (EMG), and magnetic resonance imaging (MRI) reports. All patients at a single institution who underwent US for peripheral nerve injury of the brachial plexus and terminal nerves resulting in sensory-motor deficits from October 1, 2017 to October 31, 2023 were identified. A retrospective chart review was performed. Each PE, US, EMG, and MRI reports were given an overall rating: "normal" or "abnormal." Terminal nerves (musculocutaneous, axillary, radial, ulnar, medial) were individually assessed as "normal" or "abnormal." The interobserver agreement between reports was calculated using Cohen kappa. Specificity and sensitivity analyses were performed to determine diagnostic accuracy and were reported with 95% confidence intervals (CI). A total of 120 patients were included. Most injuries were traumatic in nature (78.8%) and were low-energy (53.8%). When each imaging modality was compared with the PE findings, EMG had the highest interobserver agreement (Cohen kappa = 0.18), followed by US (Cohen kappa = 0.10), and last MRI (Cohen kappa = 0.07). The US had the highest sensitivity (0.92, CI = 0.85, 0.96) among the 3 imaging modalities (Table 2). On US, the ulnar nerve was most commonly abnormal (n = 84, 70.0%). Ultrasonography serves as a useful adjunct in the workup of patients with suspected peripheral BPI and is reliable in localizing the pathology of injured terminal nerves in the brachial plexus.

Horner’s syndrome caused by the first rib fracture sustained during coronary artery bypass grafting: a case report and literature review

BackgroundHorner’s syndrome is a rare complication of cardiovascular surgery. A bone fragment and hematoma due to rib fracture after cardiac surgery may cause injury to the brachial nerve plexus and sympathetic nerve trunk, leading to neurologic disorders and Horner’s syndrome. However, few reports have revealed the etiology of Horner’s syndrome after cardiovascular surgery based on imaging. Herein we present a case in which a plain CT scan confirmed the etiology of Horner’s syndrome after coronary artery bypass grafting (CABG), reviewing 139 CABG cases retrospectively in our hospital and 6 case reports of Horner’s syndrome associated with cardiovascular surgery.Case presentationA 69-year-old woman with a history of percutaneous coronary intervention and total abdominal hysterectomy with bilateral salpingo-oophorectomy had chest pain on exertion. Coronary angiography showed severe triple vessel disease. She underwent off-pump coronary artery bypass grafting (CABG). A median sternotomy was performed, and the split sternums were widened using a sternal retractor. The bilateral internal thoracic arteries were harvested. A triple CABG was performed. She had left shoulder pain after surgery. She complained of anhidrosis involving the left face and hyperhidrosis involving the right face from postoperative day (POD) 6. Left ptosis and blurry vision appeared after discharge from the hospital, for which she saw a neurologist in our hospital on POD 48. Miosis could not be clearly confirmed. She was diagnosed with Horner’s syndrome. A plain CT scan revealed displaced fractures of the bilateral first ribs and left second rib. The bone fragment of the left first rib head was displaced 3 mm anteriorly compared to the left first rib head before surgery, which suggested that the fragment affected the stellate ganglion in the sympathetic trunk. The patient had regular follow-up evaluations. The anhidrosis persisted, but the ptosis improved, and the miosis was not confirmed at the 6-month follow-up evaluation.ConclusionsWe should recognize that Horner’s syndrome is one of the complications of cardiovascular surgery, especially CABG. Fracture of the first rib head with a displaced bone fracture was shown to be a contributor to ipsilateral Horner’s syndrome. When symptoms of Horner’s syndrome and other neurologic symptoms are noted after open heart surgery, a plain CT examination should be obtained.

Evaluation of Brachial Plexus Nerve Variations in Axilla by Ultrasonography

The use of ultrasound in peripheral blocks has now become the gold standard. Ultrasound is a method that is easy to apply and most importantly does not carry any risk, and its only disadvantage is based on the skill and knowledge of the practitioner. Injury to vascular structures, which is the most common occurrence in peripheral block applications, has been significantly reduced by the use of ultrasound. The aim of this study is to determine the location of nerve branches and to determine the most common anthropometric parameters in the axillary fossa. In this way, the common anatomy of the axillary BP will be determined and will guide the practitioners while performing the axillary plexus block. Observational Clinical Study. The patients were positioned with forearm abducted 90 degrees and elbow flexed 90 degrees. A high-frequency linear ultrasound probe was placed on the lateral border of the pectoralis major muscle in the transverse plane. Pulsation of the axillary artery was visualized and shifted slowly to view the nerves around the artery. The axillary vein was also visualized to facilitate the movement of the transducer and to find the nerve localization more easily. The regions on the prepared wheel were marked. At the same time, demographic information such as gender, age, weight, and height of the patients were also recorded. The sample was 248 patients, 61.3% female and 38.7% male. Our results showed that only 59% were compatible with the most common nerve locations in cadaveric dissections and the locations described in anatomy textbooks. Since there are many anatomical variations, validation of nerves with a nerve stimulator as well as simultaneous visual application under ultrasound guidance will increase the success chance of axillary brachial plexus block and protect it from unwanted complications.

Diffusion-tensor magnetic resonance imaging in patients with consequences of obstetric brachial plexus palsy

BACKGROUND: Diffusion-tensor magnetic resonance imaging allows visualizing the conductive pathways of the brain and spinal cord and assessing their structure and integrity and has found wide application in practical medicine. Currently, brachial plexus diffusion-tensor magnetic resonance imaging is not a routine research technique, and very few studies have described its use in children and adolescents. AIM: This study aimed to evaluate the possibility of brachial plexus diffusion-tensor magnetic resonance imaging application in pediatric patients with obstetric brachial plexus palsy sequelae and identify correlations between the diffusion-tensor magnetic resonance imaging parameters of brachial plexus and parameters of electrophysiological study of the upper extremities in these patients. MATERIALS AND METHODS: A complex examination of 50 patients was performed. The main group included 30 patients aged 6–17 years, with contractures and secondary deformities of the bones of the shoulder girdle and upper limbs caused by unilateral obstetric brachial plexus palsy. The control group included 20 patients aged 7–17 (10.1 ± 2.1) years without clinical signs, and anamnestic data indicated the presence of damage to the brachial plexus and peripheral nerves of the upper limbs. RESULTS: No significant differences in diffusion-tensor magnetic resonance imaging parameters of the right and left brachial plexus were found in the control group. Significant differences in fractional anisotropy of the C5–C8 tracts on the side of the damaged brachial plexus were detected compared with those on the side of the undamaged brachial plexus. On the side of the injured brachial plexus, nonlinear correlations were found between the fractional anisotropy of the tracts of the spinal nerve and its branches and the amplitude of sensory responses from the sensory nerve, which originated from the anterior branches of this spinal nerve, and between the volume of the branches of the tracts of the spinal nerve and the amplitude of соmpound motor responses from the muscles, which were innervated by the anterior branches of this spinal nerve. CONCLUSIONS: Diffusion-tensor magnetic resonance imaging allows for the evaluation of the structural changes in the SNs that participate in the formation of the brachial plexus. The results can be used for further studies of diffusion-tensor magnetic resonance imaging of brachial plexuses in various pathologies in pediatric patients.

Clinicopathological and molecular genetic features of neuromuscular choristoma-associated desmoid type fibromatosis

Objective: To investigate the clinicopathological and genetic characteristics of neuromuscular choristoma-associated desmoid type fibromatosis (NMC-DF). Methods: The clinical morphological and immunohistochemical features of 7 NMC-DF cases diagnosed from January 2013 to January 2023 in Beijing Jishuitan Hospital were retrospectively analyzed. A series of neuromuscular choristoma and neuromuscular choristoma-associated desmoid type fibromatosis were evaluated for CTNNB1 mutations, and hotspot mutations for CTNNB1 were tested in 4 NMC-DF cases using Sanger sequencing. Results: The tumors were collected from 3 females and 4 males, aged 1 to 22 years (mean 7.1 years), involving the sciatic nerve (n=4), brachial plexus (n=2) or multiple nerves (n=1). The course of the disease spanned from 3 months to 10 years. Two cases were recurrent tumors. All the 7 NMC cases showed endoneurial intercalation of mature skeletal muscle fibers among the peripheral nerve fascicles, and the histologic features of the NMC-DF were strikingly similar to the conventional desmoid-type fibromatosis. By immunohistochemistry, all NMC and NMC-DF cases showed aberrant nuclear staining of β-catenin (7/7), the muscle cells in NMC were intensely immunoreactive for desmin, and the admixed nerve fibers were highlighted by NF and S-100 (7/7). Four NMC and NMC-DF had CTNNB1 mutations, 3 c.121A>G (p.T41A) and 1 c.134C>T (p.S45F). Follow-up of the 7 cases, ranging from 22 to 78 months, showed tumor recurrence in 2 patients at 3 and 8 months respectively after the first surgical resection, of which 1 patient underwent above-knee amputation. No recurrence occurred in other cases with tumor excision and neurological reconstruction surgery. There was no metastasis occurred in the 7 cases. Conclusions: NMC is a rare congenital lesion with differentiated mature skeletal muscle tissue found in peripheral nerve fascicles, and approximately 80% of patients with NMC develop a soft tissue fibromatosis. CTNNB1 mutation in the Wnt signaling pathway may be involved in the pathogenesis of NMC and NMC-DF, and S45F mutations seems to have a higher risk of disease progression.

A Comparative Study between Ultrasound Guided Interscalene and Ultrasound Guided Suprascapular Nerve Blocks in Postoperative Pain and Hand Motor Power Affection in Shoulder Scope Surgeries

Abstract Background Interscalene approach of brachial plexus nerve block is recognized as the gold standard technique for postoperative pain control after shoulder scope surgeries. However, it is associated with major adverse effects and patient discomfort due to paralysis of the hand muscles. The suprascapular nerve block is considered to be a safe and effective alternative to interscalene nerve block for shoulder surgery without affecting the motor function of the hand muscles and other serious complications of interscalene nerve block, especially in ambulatory surgery. Aim of the work The aim of this study is to compare interscalene and suprascapular nerve block in terms of postoperative pain, opioid consumption, and hand grip strength in shoulderscopic surgeries. Patients and Methods This prospective, randomized trial was done in Ain Shams University Hospitals. A sample of 50 patients; 25 patients in each group, namely Group ISB (interscalene approach of brachial plexus block) and Group SSNB (suprascapular nerve block). Visual Analogue Scale (VAS) was used to assess Shoulder pain at rest and upon flexion in the first 24 hours. The degree of hand motor power affection, the total amount of opioids used as rescue analgesia, and the incidence of complications were also recorded. Results The findings revealed no statistically significant difference between groups (p-value > 0.05) in pain control all over the 24 hours by VAS score at rest and at arm flexion. SSNB received a larger total narcotic dose (60±26.02) mg of pethidine than ISB (52±22.73). However, there was no statistical difference between them throughout the 24 hours regarding total narcotic consumption and 1st time for pethidine administration. The ISB group showed a statistically significant reduction in the hand power grip strength postoperatively (83.68±4.75 %). Conclusions The results of the present study favour SSNB as the first choice of pain control after shoulderscopic surgeries for a patient scheduled for early home discharge because of the complete recovery of the hand muscles’ motor power.

Peripheral Nerve Stimulation in Postoperative Analgesia: A Narrative Review.

Recent research has shown the effectiveness of peripheral nerve stimulators (PNS) in managing chronic pain conditions. Ongoing studies aim to explore its potential application in treating acute postoperative pain states. The purpose of this systematic review is to assess the role of PNS in providing relief for postoperative pain. Clinical studies investigating the use of peripheral nerve stimulators (PNS) for analgesia following various surgeries, such as total knee arthroplasty, anterior cruciate ligament repair, ankle arthroplasty, rotator cuff repair, hallux valgus correction, and extremity amputation, have shown promising results. Lead placement locations include the brachial plexus, sciatic, femoral, tibial, genicular, perineal, sural, radial, median, and ulnar nerves. These studies consistently report clinically significant reductions in pain scores, and some even indicate a decrease in opioid consumption following PNS for postoperative pain. PNS involves the subcutaneous placement of electrode leads to target peripheral nerve(s) followed by delivery of an electric current via an external pulse generator. While the precise mechanism is not fully understood, the theory posits that PNS modulates electrical stimulation, hindering the signaling of nociceptive pain. PNS presents itself as an alternative to opioid therapy, holding promise to address the opioid epidemic by offering a nonpharmacologic approach for both acute and chronic pain states.

Anatomical variations of the brachial plexus in adult cadavers: A descriptive study and clinical significance.

Brachial plexus injury is recognized as one of the most severe clinical challenges due to the complex anatomical configuration of the brachial plexus and its propensity for variation, which complicates safe clinical interventions. This study aimed to ascertain the prevalence and characterize the types of brachial plexus variations, and to elucidate their clinical implications. We conducted meticulous dissections of 60 formalin-fixed cadavers' upper arm, axilla and lower neck to reveal and assess the roots, trunks, divisions, cords, and branches of the brachial plexus. The pattern of branching was noted by groups of dissecting medical students and confirmed by the senior anatomists. The variations discovered were record and photographed using a digital camera for further analysis. Variations in the brachial plexus were identified in 40 of the 60 cadavers, yielding a prevalence rate of 66.7%. These variations were classified into root anomalies (2.1%), trunk anomalies (8.5%), division anomalies (2.1%), and cord anomalies (4.3%). Notably, anomalies in communicating branches were observed in 39 cadavers (83.0%): 14 with bilateral anomalies, 14 with anomalies on the left side, and 11 on the right side. These communicating branches formed connections between the roots and other segments, including trunks, cords, and terminal nerves, and involved the median, musculocutaneous, and ulnar nerves. The frequency and diversity of brachial plexus variations, particularly in communicating branches, are significant in cadavers. It is imperative that these variations are carefully considered during the diagnostic process, treatment planning, and prior to procedures such as supraclavicular brachial plexus blocks and nerve transfers, to mitigate the risk of iatrogenic complications.

Origin and distribution of the brachial plexus in red-necked wallaby (Notamacropus rufogriseus, Marsupialia: Macropodidae).

Notamacropus rufogriseus (red-necked wallaby) are in the family Macropodidae, which is the second largest family of marsupials after the family Didelphidae. This study was conducted with the aim of providing a detailed description of the origin and distribution of the brachial plexus in N. rufogriseus. Two-year-old male and 3-year-old female red-necked wallabies were used for the study. The brachial plexus was formed by ventral rami of C4, C5, C6, C7, C8, and T1 spinal nerves. It is composed of three trunks that give rise to 12 principal nerves. The cranial trunk is formed by the combination of the rami C4-C7; the middle trunk is formed by the combination of the rami C6 and C7; and the caudal trunk is formed by the combination of the rami C8 and T1. Differences between left and right side of the plexus brachialis were not observed. C6 ventral spinal rami contribute the most to brachial plexus nerve formation, while C4 contributes the least. The formation and distribution of the plexus in N. rufogriseus exhibited more resemblance to the patterns observed in marsupial animals rather than placental mammals. Marsupial mammals demonstrate the involvement of C4 in the development of the brachial plexus. The formation and branching of the brachial plexus sequentially adapt in accordance with changes in their thoracic limb activities and innervation points. Anatomical data from brachial plexus studies optimizes thoracic limb clinical and surgical treatments. This work can provide baseline data for future marsupial brachial plexus studies and fill gaps in the scarce literature.

A randomised trial comparing block characteristics of a mixture versus sequential injections of lignocaine and ropivacaine for supraclavicular brachial plexus nerve block in patients undergoing upper limb surgery.

There is no consensus on the appropriate use of mixtures of local anaesthetic drugs in various combinations for nerve blocks. We intended to compare short-acting lignocaine and long-acting ropivacaine as a mixture versus undiluted sequential injections on block characteristics of ultrasound-guided (USG) supraclavicular brachial plexus block for upper limb surgeries. A double-blinded randomised study was conducted on 64 adult patients scheduled for upper limb surgery who received 15 mL each of 2% lignocaine with adrenaline and 0.75% ropivacaine as a 1:1 mixture in the mixed group (Group M) or sequential injections in the sequential group (Group S) by using a USG technique. The primary outcome was the percentage of participants with complete four nerve sensory blocks at 10 minutes post block injection. Secondary outcomes were sensory and motor block characteristics till 30 minutes, total duration of analgesia, sensory and motor block, and complications. Demographic characteristics and time taken for the procedure were similar. The percentage of participants with a complete four-nerve sensory block at 10 minutes was higher in Group S (69%) versus Group M (41%) (P = 0.04). Complete sensory and motor block rates were similar at 30 minutes. The block procedure time, total duration of analgesia, and sensory and motor block were similar in both groups. There were no major complications. Sequential lignocaine-ropivacaine, compared to the mixed injection technique, has a higher initial rate of sensory and motor block onset with a similar total block duration.

Combined ultrasound‐ and nerve stimulator‐guided brachial plexus nerve block in a pig undergoing olecranon fracture repair

AbstractA male pot‐bellied pig was presented for left thoracic limb lameness. A fracture of the olecranon apophysis with displacement was diagnosed, and fracture stabilisation was performed under general anaesthesia. After anaesthetic induction, an axillary brachial plexus nerve block (BPB) with bupivacaine was performed using a portable ultrasound device and a nerve locator. Heart rate and blood pressure were monitored for nociception and the need for analgesic intervention during the procedure. No analgesic intervention was deemed necessary, as the pig did not meet predefined nociceptive thresholds. The pig recovered from general anaesthesia uneventfully without clinical signs of pain or complications. The affected limb was knuckled and lacked conscious proprioception immediately after recovery. Sixteen hours after BPB, knuckling resolved, and normal conscious proprioception was observed. No obvious adverse effects from BPB were noted. The combination of ultrasound and nerve stimulator‐guided BPB with bupivacaine was successful in a pig.

A meta-analysis of unilateral axillary approach for robotic surgery compared with open surgery for differentiated thyroid carcinoma.

The Da Vinci Robot is the most advanced micro-control system in endoscopic surgical instruments and has gained a lot of valuable experience today. However, the technical feasibility and oncological safety of the robot over open surgery are still uncertain. This work is to systematically evaluate the efficacy of the unilateral axillary approach for robotic surgery compared to open surgery for differentiated thyroid carcinoma. PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to search for relevant literatures of robotic thyroid surgery using unilateral axillary approach compared to open thyroid surgery, and a meta-analysis was performed using RevMan software version 5.3. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods. Twelve studies with a total of 2660 patients were included in the meta-analysis. The results showed that compared with the open group, the robotic group had a longer total thyroidectomy time, shorter hospital stay, less intraoperative bleeding, more postoperative drainage, fewer retrieved central lymph nodes, and higher cosmetic satisfaction (all P < 0.05). In contrast, temporary and permanent laryngeal recurrent nerve injury, temporary and permanent hypoparathyroidism or hypocalcemia, brachial plexus nerve injury, number of retrieved central lymph nodes, number of retrieved lymph nodes in the lateral cervical region, number of lymph node metastases in the lateral cervical region, hematoma, seroma, lymphatic leak, stimulated thyroglobulin (sTg) and unstimulated thyroglobulin (uTg), and the number and recurrence rate of patients with sTg <1ng/ml were not statistically different between the two groups (P > 0.05). The unilateral axillary approach for robotic thyroid surgery may achieve outcomes similar to those of open surgery. Further validation is required in a prospective randomized controlled trial.

Optimising safe margins in shoulder surgeries: a cadaveric study on brachial plexus nerves with anthropometric and movement correlation.

Shoulder surgeries, vital for diverse pathologies, pose a risk of iatrogenic nerve damage. Existing literature lacks diverse bone landmark-specific nerve position data. The purpose of this study is to address this gap by investigating such relationships. This cadaveric study examines axillary, radial and suprascapular nerves' relation with acromion, coracoid and greater tuberosity of the humerus (GT). It also correlates this data with humeral lengths and explores nerve dynamics in relation to arm positions. The mean distance from the axillary nerve to (i) GT was 4.38cm (range 3.32-5.44, SD 0.53), (ii) acromion was 6.42cm (range 5.03-7.8, SD 0.694) and (iii) coracoid process was 4.3cm (range 2.76-5.84, SD 0.769). Abduction brought the nerve closer by 0.36cm, 0.35cm and 0.53cm, respectively. The mean distance from radial nerve to (i) GT was 5.46cm (range 3.78-7.14, SD 0.839), (ii) acromion was 7.82cm (range 5.4-10.24, SD 1.21) and (iii) tip of the coracoid process was 6.09cm (range 4.07-8.11cm, SD 1.01). The mean distance from the suprascapular nerve to the acromion was 4.2cm (range 3.1-5.4, SD 0.575). The mean humeral length was noted to be 27.83cm (range 25.3-30.7, SD 1.13). There was no significant correlation between these distances and humeral lengths. It is essential to exercise caution to avoid axillary nerve damage during the abduction manoeuvre, as its distance from the greater tuberosity and tip of the coracoid process has shown a significant reduction. The safe margins, in relation to the length of the humerus and consequently the patient's stature, exhibit no significant variation. In situations where the greater tuberosity (GT) and the border of the acromion are inaccessible due to reasons such as trauma, the tip of the coracoid process can serve as a dependable bone landmark for establishing a secure surgical margin.

Acute pain syndromes in injuries to the nerves and plexuses of the limbs

Injuries of peripheral nerves and plexuses cause serious disorders in the affected limbs. Unfortunately, the frequency of nerve injuries and limb plexuses is steadily increasing in our country, due to hostilities, which emphasizes the extreme relevance of this pathology. The aim of the review is to consider the current data on pathophysiological mechanisms, clinical manifestations, and treatment of acute pain syndromes in patients with injuries of peripheral nerves and limb plexuses. Materials and methods. Scientific databases PubMed, Google Scholar, Scopus, Cochrane Library, as well as the materials of the International Association for the study of pain were used to search for sources of research information. The main studies were found in Pubmed, Google Scholar and materials of the International Association for the study of pain and made up 191 sources of information, 150 of which were excluded from the review due to insufficient data on pathophysiological mechanisms, clinical manifestations, and treatment of pain syndromes in patients with damage to the nerves and plexuses of the limbs, thus 41 sources of information formed the basis of the review. Results: Brachial plexus and peripheral nerve injuries can be associated with any combination of nociceptive, neuropathic, phantom limb pain, and even complex regional pain syndromes. Acute neuropathic pain is an under-recognized condition, often difficult to treat and can progress to persistent pain and disability. Neuropathic pain develops because the main damage affects the somatosensory system. It is caused by peripheral nerve damage and associated changes in the central nervous system. The first line of pharmacological treatment for neuropathic pain according to current guidelines is anticonvulsant drugs that affect neuronal calcium channels, as well as tri- and tetracyclic antidepressants and selective serotonin/norepinephrine reuptake inhibitors. Conclusions: At the current stage, progress has been made in understanding the mechanisms of development of the pathological condition and in the development of therapeutic approaches, however, the chronicity of pain syndrome in patients with damage to the nerves and plexuses of the limbs is still high, which requires further research to develop complex pathogenetic therapy and better understanding of the mechanisms pain in this category of patients

Advancements in autologous peripheral nerve transplantation care: a review of strategies and practices to facilitate recovery.

Autologous peripheral nerve transplantation, a pioneering technique in nerve injury treatment, has demonstrated remarkable progress. We examine recent nursing strategies and methodologies tailored to various anatomical sites, highlighting their role in postoperative recovery enhancement. Encompassing brachial plexus, upper limb, and lower limb nerve transplantation care, this discussion underscores the importance of personalized rehabilitation plans, interdisciplinary collaboration, and innovative approaches like nerve electrical stimulation and nerve growth factor therapy. Moreover, the exploration extends to effective complication management and prevention strategies, encompassing infection control and pain management. Ultimately, the review concludes by emphasizing the advances achieved in autologous peripheral nerve transplantation care, showcasing the potential to optimize postoperative recovery through tailored and advanced practices.

Intraoperative neuromonitoring in surgery of cervical neurogenic tumors

Objective: To investigate the application value of intraoperative motor nerve monitoring in cervical neurogenic tumor surgery. Methods: The efficacy of intraoperative neuromonitoring (IONM) was analyzed retrospectively in 18 patients, including 6 males and 12 females, aged from 15 to 74 years, treated in Affiliated Drum Tower Hospital, Medical School of Nanjing University from June 2019 to September 2022 who underwent total cystectomy of cervical neurogenic tumors under intraoperative nerve monitoring. Results: All 18 patients had complete tumor removal, including 8 patients with tumors from the vagus nerve and 10 patients with tumors from the brachial plexus nerve. Postoperative nerve functions were normal in patients with tumors from brachial plexus nerve, and incomplete vocal cord paralysis occurred in 2 patients with tumors from vagus vagus nerve. The total incidence of motor nerve injury was 11.1% (2/18). All patients were followed up for 6 to 45 months, with no tumor recurrence. Conclusion: Intraoperative neuromonitoring has significant values in surgery of cervical neurogenic tumors, which is helpful to remove completely the tumors on the basis of protecting the nerve functions to the maximum extent.

Growth of the brachial nerve plexus with reference to topographical relation of the medianus nerve ansa with the thoracic wall and shoulder: a histologic study using human embryos and fetuses.

There is currently no information on positional changes in the brachial nerve plexus during prenatal growth. The subclavian-axillary artery passing through the medianus nerve ansa is considered a good landmark for evaluating the height of the plexus. We used histologic sections from 9 embryos and 17 fetuses (approximately 6-15weeks of gestational age) to identify the height of the ansa by referring to the level of the rib and the glenohumeral joint. The nerve ansa was usually (23 plexuses) observed at the level of the first and/or second ribs. However, it was sometimes observed above the first rib, at a distance equal to or more than an intercostal width (7 plexuses). In the latter group, the ansa was usually located below the glenohumeral joint. Thus, the joint was located higher than the first rib, although the upper extremities were in the anatomic position for all specimens. The left-right difference in the height of the plexus corresponded to or was less than the width of the first intercostal space. Despite the synchronized growth between the thorax and shoulder girdle, the brachial plexus showed a considerable variation in comparative height; the range corresponded to twice of an intercostal width. Whether the nerve plexus is located high or low is determined at an early developmental stage and is maintained during the later growth stages. The high-positioned plexus might cause nerve injury at delivery, followed by a glenohumeral joint deformity because of the fragility without fixation in the thorax.

Effect of intravenous dexmedetomidine as an adjuvant to brachial plexus block in upper limb orthopedic surgeries – A systemic review and meta-analysis

Brachial plexus block for upper limb orthopedic surgeries has been widely used for surgical anesthesia and post operative analgesia. Various adjuvants are used to prolong the duration of the nerve block. Systemic dexmedetomidine as an adjuvant to local anesthetics has been shown to prolong the duration of the nerve block in some randomized controlled trials (RCTs) but is far from unanimous in its efficacy. Hence, an updated meta-analysis was planned to assess the efficacy and safety of systemic dexmedetomidine as an adjuvant to local anesthetics in brachial plexus nerve block (BPNB). Objective of the study is to assess the duration of analgesia in patients undergoing upper limb orthopaedic procedures with BPNB and intravenous dexmedetomidine as an adjuvant. Data sources were PubMed, Cochrane, and Google Scholar were systematically searched till July 2023. The meta-analysis included all published studies that investigated the effect of systemic dexmedetomidine on duration of analgesia following BPNB. The data extraction was guided by a predetermined checklist. Analysis was done Using RevMan_5 software, the mean difference for duration of analgesia between the two groups and odds ratio was calculated from the selected studies. The fixed-effects model was used to compare the difference in the duration of analgesia between the two groups. The outcome was prolonged duration of analgesia in patients undergoing upper limb orthopedic procedure where intravenous dexmedetomidine was used as an adjuvant to peripheral nerve blocks. Our meta-analysis currently generates the evidence that intravenous dexmedetomidine administration offers advantages over other drugs in terms of prolonged duration of analgesia.

Rehabilitation protocols in neonates undergoing primary nerve surgery for upper brachial plexus palsy: A scoping review.

Surgical management is recommended in patients with severe neonatal brachial plexus palsy (NBPP) within the first 6 months of age to regain best possible function. Rehabilitation post-surgery remains relatively unexplored. This is a scoping review that explores, which rehabilitation modalities exist and how they vary for different microsurgical approaches in NBPP. A systematic search was conducted to include articles about upper trunk obstetric brachial plexus nerve microsurgery in pediatric patients that made mention of rehabilitation protocols. The aims of rehabilitation modalities varied and were grouped: "passive" movement to prevent joint contracture or stiffness, "active" or task-oriented movement to improve motor function, or "providing initial motor recovery". Surgical approach was described as either exploration of the brachial plexus (EBP) or nerve transfer without root exploration (NTwoRE). Technique was categorized into transfers and non-transfers. Thirty-six full-text articles were included. Initiation of rehabilitation was 22.26 days post-surgery. Twenty-eight studies were EBP, and six were NTwoRE. Of studies classifiable by aims, nine were "passive", nine were "active", and five were "providing initial motor recovery". Only 27.7% of EBP studies mentioned active therapy, while 75.0% of NTwoRE studies mentioned active therapy. The average age of patients in the EBP procedure category was 7.70 months, and NTwoRE was 17.76 months. Within transfers, the spinal accessory to suprascapular group was more likely to describe an active shoulder exercise therapy, whereas contralateral C7 group was more likely to describe "initial motor recovery", especially through the use of electrostimulation. All articles on electrostimulation recommended 15-20-minute daily treatment. Information on rehabilitation is limited post-nerve surgery in NBPP. However, when mentioned, the aims of these therapies vary with respect to surgical approach and technique. The type of therapy to employ may be a multifaceted decision, involving factors such as patient age, initial deformity, and goals of the care team.