Case Report
Stellate Ganglion Block Followed By Hydro-Dissection Improved The Functioning of 4 Months Old Brachial Plexus Injury
R.K. Gautam*, A.K. Paswan, Shashi Prakash, N. Verma
Department of Anesthesiology, Pain management Division, Institute of Medical Sciences, Banaras Hindu University, India
R.K. Gautam, Department of Anesthesiology, Pain management Division, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Received Date: May 17, 2021; Published Date:July 09, 2021
Abstract
Objective: To report a case of 4 month old Brachial plexus injury leading to Axillary nerve and Musculocutaneous nerve axonal involvement, improved post Stellate ganglion block and hydro-dissection.
Summary of background: Trauma leading to physical work limitation specially of upper limb can be extremely worrisome in individual, most importantly if he is the sole bearer of a family. This case presented by us, will clearly depict that if an appropriate diagnostic setting and step-wise approach is used, the Brachial Plexus injury leading to CRPS-II can be improved with better outcome in the physical functioning of the affected limb.
Method: A 55-year-old patient presented to the Pain management department with complains of pain in Left arm, forearm, and hand with paresis. This started after an event of fall from a running bike about 4 months back. The power in his shoulder was 2/5, Elbow 1/5 and wrist 1/5. He also complained of severe paroxysmal pain of sharp, stabbing character in his entire arm majorly on lateral side with a continuous dull deep aching pain. He was having loss of hair on his hand with swelling mostly on the wrist’s dorsum aspect. CRPS 2 was provisionally thought and was taken for SGB block, which improved his pain and sudomotor signs. In the next sitting, Hydro-dissection was performed in the injured Brachial plexus site with 0.9% normal saline at the trunk and division level which led to improvement in his power over a period of 1 month time.
Result: A prompt diagnosis of CRPS-2 with appropriate sympathetic block can help in preventing the further progress. Also, even after 4 months of the injury, an apt hydro- dissection to relieve the post traumatic fibrosis can improve the nerve conduction and can eventually save the limb.
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R.K. Gautam, A.K. Paswan, Shashi Prakash, N. Verma. Stellate Ganglion Block Followed By Hydro-Dissection Improved The Functioning of 4 Months Old Brachial Plexus Injury. Anaest & Sur Open Access J. 2(5): 2020. ASOAJ.MS.ID.000547.
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