Anaesthetic challenges in paediatric reconstructive surgery for obstetric brachial plexus palsy: A retrospective case series

• Author Details:   
• Sharmila Somayaji
• Mohammed Yaqub
• Sarah Shahnaz S ^*
• Mithun Dharmlingam
• Y R Chandrika

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Background: Obstetric brachial plexus palsy (OBPP) is an injury to the C5-T1 nerve roots of the brachial plexus due to traction during delivery. While some cases resolve spontaneously, others require surgical intervention. Anaesthetic management in these cases can be challenging, especially in infants and young children undergoing reconstructive procedures.

Objective: To evaluate the anaesthetic strategies and challenges encountered in the perioperative management of paediatric patients undergoing various surgical corrections for OBPP.

Materials and Methods: A retrospective analysis was conducted on 10 paediatric patients diagnosed with OBPP who underwent reconstructive surgeries at a tertiary center. Surgical procedures included nerve grafting, tendon transfers, muscle releases, and Botox injections. Data collected included demographics, type of surgery, anaesthetic technique used, intraoperative monitoring, airway management, use of regional anaesthesia, and perioperative complications.

Results: Patient-tailored anaesthetic approaches were planned according to age and the surgical procedure. General anaesthesia with endotracheal intubation was used in all patients. Regional anaesthesia was selectively applied depending on the surgical site for analgesia. Intraoperative considerations included avoiding muscle relaxants during nerve stimulation, maintaining normothermia, and using total intravenous anaesthesia (TIVA). No major anaesthetic complications were reported. All patients had an uneventful recovery.

Conclusion: Anaesthetic management in OBPP surgeries requires meticulous planning, individualized techniques, and multidisciplinary coordination. Understanding the specific challenges posed by paediatric neuro-reconstructive surgery helps optimize outcomes and minimize risks. Our case series reinforces the importance of tailored anaesthetic protocols and highlights the safety of current practices when implemented with caution.