Patient Suffers Brachial Plexopathy After Palmar Fasciotomy Procedure

Case Overview

This case study delves into an incident involving a 56-year-old patient who underwent a palmar fasciotomy for Dupuytren’s contracture. The procedure involved a nerve block administered to the patient’s shoulder by a Certified Registered Nurse Anesthetist (CRNA) student under the supervision of an experienced CRNA.

During the procedure, it was alleged that the supervising CRNA cautioned the student about their proximity during the nerve block administration. Following the procedure, the patient experienced difficulty gripping, and subsequent nerve conduction studies revealed brachial plexopathy.

Despite consultations with multiple surgeons, the patient continues to suffer from muscle wasting, impaired grip strength, and inability to lift their left arm.

This case seeks expert opinion on CRNA Best Practices and standard of care.

Questions to the expert and their responses

How often do you manage CRNA students performing nerve blocks?

Throughout my 37-year career as a clinical instructor, I supervised nurse anesthesia students across various cases and anesthetics, including peripheral nerve blocks (PNBs). Even after my retirement in October 2021, I continue to teach students.

What protocols are in place to ensure that a student does not harm a patient when performing a nerve block?

Several protocols are followed to maintain high care standards while supervising students.

These include ensuring comprehensive anatomical knowledge of the area being blocked, utilizing ultrasound-guided imagery, and employing peripheral nerve stimulation. Each step performed by the student is vigilantly monitored by the instructor to guarantee patient safety and the correct delivery of anesthesia care.

Have you ever reviewed a similar case? If yes, please elaborate.

Yes, I have reviewed several cases concerning nerve injuries in PNBs. One such case is currently under review in Arizona.

About the expert

This expert has an extensive background in nursing, with over 35 years of experience specializing as a nurse anesthetist. They hold degrees from prestigious universities and are both a licensed registered nurse and a certified registered nurse anesthetist. Their professional history includes roles such as staff registered nurse in critical care units, associate director for a School of Anesthesia, program director of an anesthesia technician program, and currently serves as an adjunct professor, faculty member at two universities, and a didactic instructor and consultant at a large medical group.