Brachial Plexus Block Following Serratus Anterior Plane Block After Minimally Invasive Cardiac Surgery Identified...

Area of Science:

• Anesthesiology
• Pain Management
• Neurosurgery

Background:

• Serratus anterior plane block (SAPB) is effective for pain control after minimally invasive cardiac surgery (MICS).
• Rare neurological complications associated with SAPB have been reported.
• Accurate catheter placement is crucial for effective and safe regional anesthesia.

Purpose of the Study:

• To report a case of upper limb neurological symptoms following SAPB after MICS.
• To illustrate the importance of imaging and monitoring for atypical SAPB catheter spread.
• To highlight potential complications and management strategies for SAPB.

Main Methods:

• A case of a 74-year-old woman undergoing aortic valve replacement via minithoracotomy.
• Preoperative placement of a SAPB catheter deep into the serratus anterior muscle (SAM).
• Postoperative contrast x-ray imaging to visualize catheter distribution and programmed intermittent bolus infusion (PIBI).

Main Results:

• Contrast imaging revealed atypical spread from the chest wall towards the right upper arm, suggesting catheter migration.
• The patient developed reduced grip strength and sensory deficits in the right arm after PIBI initiation.
• Neurological symptoms resolved upon discontinuation of PIBI, indicating a likely catheter-related cause.

Conclusions:

• Atypical contrast spread patterns in SAPB may indicate catheter migration and risk neurological complications.
• Close monitoring for neurological symptoms is essential, especially when unusual contrast distribution is observed.
• Confirmation of catheter placement and prompt management are critical for patient safety in regional anesthesia.