A case of peripheral neuropathy after axillary brachial plexus block in a patient with CREST syndrome

DOI
  • OIKAWA Koh
    Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine
  • ONISHI Eiko
    Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine
  • YABUKI Shizuha
    Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine
  • SUZUKI Jun
    Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine
  • KUMAGAI Michio
    Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine
  • YAMAUCHI Masanori
    Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine

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Other Title
  • 腋窩アプローチによる腕神経叢ブロック後に末梢神経障害を呈したCREST症候群合併患者の1症例

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<p>The patient is a 41-year-old woman diagnosed with CREST syndrome three years ago. A lumpectomy was scheduled under an axillary brachial plexus block for a finger calcification lesion associated with this disease. The ultrasound-guided nerve block was performed with 25 ml of 0.25％ levobupivacaine, mainly on the median and radial nerves. No abnormal sensations were noted at the time of puncture. She complained of prolonged numbness and pain from the left forearm to the entire fingers after surgery. She exhibited allodynia on the ulnar side, with no signs of motor paralysis or sensory loss. She had Raynaud's phenomenon, and a history of marked ischemic changes at the finger ends after finger block. The cause of the peripheral neuropathy in the present case was thought to be nerve damage from the needle, nerve ischemia from local anesthetic, and hyperextension or compression due to intraoperative and postoperative positioning.</p>

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