Positioning for the Nuss procedure: avoiding brachial plexus injury.

Area of Science:

• Thoracic Surgery
• Pediatric Surgery
• Orthopedic Surgery

Background:

• The Nuss procedure is a minimally invasive technique for pectus excavatum repair with excellent outcomes.
• Potential complications include cardiothoracic injuries, arrhythmias, pneumothorax, pleural effusions, hemorrhage, and brachial plexus injury due to patient positioning.
• Modified patient positioning strategies are crucial for mitigating risks associated with the Nuss procedure.

Purpose of the Study:

• To evaluate the incidence of brachial plexus injury in patients undergoing the Nuss procedure.
• To compare the outcomes of standard arm positioning versus a modified positioning technique using an arthroscopy sling and suspension device.
• To identify a positioning method that minimizes the risk of transient brachial plexus palsy.

Main Methods:

• A retrospective chart review of 95 pediatric patients who underwent the Nuss procedure.
• Group 1 (n=58): Arms positioned 90 degrees at the shoulder.
• Group 2 (n=37): Arms positioned in a neutral position using an arthroscopy sling and suspension device.

Main Results:

• Three of 58 patients (5.2%) in the standard positioning group experienced transient brachial plexus injuries.
• No brachial plexus injuries were reported in the group utilizing the arthroscopy sling and suspension device.
• The modified positioning technique demonstrated a significant reduction in brachial plexus injuries.

Conclusions:

• Patient arm positioning during the Nuss procedure is a critical factor in preventing brachial plexus injuries.
• An arthroscopy sling and suspension device effectively maintains a neutral arm position, eliminating transient brachial plexus palsy.
• This readily available device allows for intraoperative manipulation while mitigating the risk of iatrogenic brachial plexus injury.