Brachial Plexus Damage From Inter Scalene Block and Pain Management Procedure

This case involves a patient that alleges a CRNA (certified registered nurse anesthetist) damaged the brachial plexus while performing an inter scalene block procedure. The CRNA states that there was some trouble penetrating the skin and the needle never went more than 1/4″ deep. Thus, it was not in the vicinity of the nerve plexus.

Question(s) For Expert Witness

  • 1. What could have been done differently to prevent the alleged damage?

Expert Witness Response E-005130

The use of ultrasound can make it easier to locate the brachial plexus, especially in obese patients. It also allows practitioners to see that the local anesthetic is going where they intend it to go. For example, it is possible with nerve stimulation techniques to stimulate the plexus while outside the fascial compartment. Therefore, the local anesthetic injection would not damage plexus.


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