American Society for Peripheral Nerve

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Preoperative and Postoperative Clinical Comparison in Patients with Brachial Plexus Injury with or without Nerve Recording
Federico García García, Resident; Alexander Cárdenas Mejía, MD
Plastic and Reconstructive Surgery, Hospital General Dr. "Manuel Gea González", Mexico City, Mexico

Introduction: Brachial plexus injuries are one of the most devastating lesions for the patient; causing function loss of the daily life and occupational activities. The accuracy of a diagnostic test for classifying a patient is a key point to make a treatment decision. In order to establish a diagnostic and offer a treatment in a patient with brachial plexus injury we have to base on physical examination and complementary paraclinic studies. The presurgical low specificity and positive predicted value in the electrophysiology studies are the main indication to perform a intraoperative nerve recording.

Methods: Patients with brachial plexus injury were evaluated, from 2007 to 2014. Two groups were formed, depending on the performance or absence of intraoperative nerve recording. Their pre and post-surgery videos were reviewed and rated according to a scale based on the Narakas and Raimondi valuation table (shoulder abduction, external rotation, retropulsion and thoracobrachial adduction / elbow flexion and extension / forearm pronosupination / wrist flexion and extension / thumb, central fingers and fifth finger movement).

Results: 25 patients, 17 men (68.0%) and 8 women (32.0%), with age range of 1-54 years (mean 28.1 ± 1.28) were obtained. 52% were right brachial plexus injuries and 48% left. We get 15 patients in the group with intraoperative nerve recording and 10 patients in the second group (without nerve recording). 72% of the brachial plexus injury was secondary to motor vehicle accident (car and motorcycle). All postoperative assessments showed a statistically significant improvement (p <0.05) regardless either of the presence or the absence of intraoperative nerve recording. During the postoperative evaluation of the the group with intraoperative monitoring, shoulder external rotation and movement of the middle fingers obtained statistically significant improvement (p <0.05); in comparison to the group without nerve recording. Thoracobrachial adduction was found with bordering statistically significant value (p=0.084). In the postoperative evaluation, 52.4% of patients presented with intraoperative nerve recording arose in 1 or more of the ranges of the rating scale; whereas in patients without it only 22.7% had increased. None of the patients (regardless of the performance or absence of intraoperative nerve recording) gave a lower score while postoperative assessment.

Conclusions: The intraoperative nerve recording studies provide better clinical outcomes in the postoperative period in patients with brachial plexus injury; this can be attributed to the intraoperative information obtained during brachial plexus exploratory surgery.

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