CONGRESS ABSTRACT

It is well known that brachial plexus injury can be a complication of open heart surgery. Most of these injuries are caused by stretching of the lower roots (C8-T1) during sternal retractor placement and present as ulnar neuropathy in the postoperative period. However, these peripheral nerve problems are often overlooked. We report the case of a 72-year-old man with a medical history of type 2 diabetes mellitus, hypertension, hypercholesterolaemia, a history of tobacco use and overweight (BMI=27). The patient underwent off-pump CABG (from the left internal mammary artery to the left anterior descending artery; from the saphenous vein to the first marginal artery and to the posterior interventricular artery) for low-stress angina in triple-vessel coronary artery disease. The surgery was complicated by the development of neuropathic pain, mainly at night, in the fourth and fifth fingers of the left hand. Particularly severe and persistent pain symptoms led to sleep deprivation and hampered functional recovery during cardiac rehabilitation.  Therefore, neurophysiopathological evaluation by electromyography was requested three months after surgery. The examination revealed evidence of left brachial plexus disease with myelin axonal degeneration of the C6-C7-C8 nerve roots. Treatment with pregabalin 75 mg twice daily showed no significant improvement. Only the addition of tapentadol 50 mg twice daily resulted in complete resolution of the pain symptoms. With the problem of neuropathic pain resolved, the patient was able to rest well at night, with significant benefits to his physical and psychological wellbeing. The prognosis for brachial plexus neuropathy after heart surgery is generally good. However, there is sometimes a delay in recovery up to a year. Persistent symptoms can affect quality of life and interfere with rehabilitation programmes. The clinical signs and symptoms of brachial plexus injury should be investigated: paresthesias or pain in the upper limbs and any associated motor deficits (shoulder elevation; adduction, abduction, lateral and medial rotation of the arm; thumb flexion and opposition). Pain can be controlled with medication. Motor deficits can be improved with specific physiotherapy exercises. Therefore, postoperative iatrogenic peripheral neuropathies are not a negligible problem, but need to be diagnosed, properly treated and followed up over time.