Feasibility and Safety of Brachial Plexus Blocks in Patients With Cervical Spinal Cord Injury Undergoing Upper Extremity Surgery: Case Series

Upper extremity reconstructive surgeries in patients with cervical spinal cord injury (SCI) can significantly improve function, but anesthesia planning and postoperative pain management are complex. Continuous peripheral nerve blocks (CPNBs) may offer intraoperative anesthesia and postoperative analgesia benefits, yet literature on their safety and patient tolerance in those with cervical SCI is limited. This case series reviewed the records of 18 patients with cervical SCI who underwent upper extremity tendon transfer, nerve transfer, or reconstructive surgery and received an ultrasound-guided brachial plexus CPNB maintained for up to 7 days postsurgery. The retrospective chart review focused on CPNB-related neurological symptoms, patient experiences with a new insensate limb, postsurgical opioid use up to postoperative day (POD) 7, and the return of bowel function. The mean duration of CPNB infusion was 3.5 days. No patients exhibited new neurological symptoms or unpleasant experiences necessitating removal of the CPNB. Most patients returned to baseline opioid use by POD 5 and had a bowel movement by POD 1. The findings suggest that brachial plexus CPNB infusions are well tolerated in patients with cervical SCI, providing effective pain relief and minimizing opioid usage without causing distress related to a new insensate limb.