Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Brachial plexus injects are common procedures for pain management of the upper limb. Complications from theses injections, however, can be severe leading to permanent neurological deficit. The purpose of this technical report is to introduces a safe novel approach for brachial plexus injections.
CASE PRESENTATION: A 45-year-old woman with type 2 complex region pain disorder underwent a novel brachial plexus injection. The patient was brought to the operating room where fluoroscopy was used to locate the T2 lamina. A 17-gauge introducer needle was maneuvered through the interlaminar space and into the epidural space. The stylet was removed and a Brevi Kath® (Epimed, Dallas, TX) was passed through the C7-T1 foramen into the brachial plexus region. Contrast was used to ensure proper placement and absence of vascular pickup. The injection was then given, and the catheter withdrawn. The procedure was done without complication and the patient had a 40% reduction in pain symptoms based on a visual analog scale. She was cleared to restart physical therapy.
CONCLUSIONS: This novel technique approaches the brachial plexus by gaining access to the thoracic epidural space and following the spinal nerves through their respective foramen. The use of fluoroscopy and contrast ensures correct placement of injection. A blunt catheter limits the risk of injury. This approach may benefit patients who have failed standard techniques using local landmarks or those that are not ideal candidates due to previous injury or pre-existing conditions.
KEY WORDS: Interventional pain, injection, brachial plexus, pain management, fluoroscopy