From the Guidelines
The phrenic nerve can indeed be injured during surgeries on the brachial plexus, although the provided evidence does not directly discuss brachial plexus surgeries, it highlights the vulnerability of the phrenic nerve in other types of surgeries. This is crucial because the phrenic nerve's anatomical path, originating from cervical nerve roots C3-C5 and descending through the neck, positions it near the brachial plexus, thereby increasing its susceptibility to injury during surgical procedures in this region 1.
Key Considerations
- The risk of phrenic nerve injury is a significant concern due to its potential to cause diaphragmatic paralysis, leading to respiratory complications such as shortness of breath, reduced lung capacity, and in severe cases, respiratory failure.
- Although the evidence provided discusses robotic-assisted mitral valve surgery 1, the principle of nerve vulnerability during surgical procedures applies broadly, including surgeries on the brachial plexus.
- Surgeons must take precautions to identify and protect the phrenic nerve during these procedures, and patients should be informed about this potential complication during the consent process.
Clinical Implications
- The proximity of the phrenic nerve to the brachial plexus necessitates careful surgical planning and execution to minimize the risk of injury.
- Intraoperative nerve monitoring can be a valuable tool in reducing the risk of phrenic nerve injury during surgeries in this region.
- Patients undergoing brachial plexus surgery should be closely monitored post-operatively for signs of phrenic nerve injury, and early intervention should be considered if such complications arise.
From the Research
Phrenic Nerve Injury in Brachial Plexus Surgeries
- The phrenic nerve can be injured during surgeries on the brachial plexus, as it is often used as a donor nerve for transfer in severe brachial plexus injuries 2.
- Studies have shown that phrenic nerve transfer can be an effective and safe procedure for restoring arm function in patients with brachial plexus avulsion injuries, with minimal risk of respiratory complications 3, 4.
- However, anatomic variations of the phrenic nerve and brachial plexus can increase the risk of nerve injury during surgery, and surgeons should be aware of these variations to minimize postoperative complications 5.
- The incidence of phrenic nerve injury associated with brachial plexus trauma can range from 10% to 20%, and unilateral diaphragmatic paralysis may often present without symptoms at rest, making it important to carefully evaluate patients for potential phrenic nerve injuries 6.
Risk Factors and Complications
- Age and body mass index have been identified as predisposing factors for poorer pulmonary performance after phrenic nerve transfer, with cut-off values of younger than 32 years old and less than 23, respectively 4.
- Transient phrenic nerve injury with postoperative elevation of the ipsilateral hemidiaphragm has been documented in some patients, but permanent phrenic nerve injury is rare 5.
- Respiratory function tests may be affected by phrenic nerve transfer, but this rarely correlates with clinical symptoms, and most patients do not experience significant respiratory complications 2, 3.