Disease relevance of Brachial Plexus

• Hereditary neuralgic amyotrophy with predilection for the brachial plexus (HNA) and hereditary neuropathy with liability to pressure palsies (HNPP) are autosomal dominant disorders associated with episodic, recurrent brachial neuropathies [1].
• We conclude that the controlled release of bupivacaine from microspheres prolonged the brachial plexus block without obvious toxicity [2].
• We report a patient to whom ropivacaine 1.1 mg kg(-1) was administered for brachial plexus blockade and who developed grand mal convulsions because of inadvertent i.v. injection [3].
• The incidence of brachial plexus injury increased with increasing birth weight, operative vaginal delivery, and the presence of glucose intolerance [4].
• Neuromuscular hamartoma (benign "triton" tumor) of the brachial plexus. Case report [5].

Psychiatry related information on Brachial Plexus

• Reactivation of phantom limb pain after combined interscalene brachial plexus block and general anesthesia: successful treatment with intravenous lidocaine [6].
• When considering levobupivacaine and ropivacaine for brachial plexus anesthesia, levobupivacaine should be considered when postoperative analgesia is a concern but not when an early return of motor activity is required [7].

High impact information on Brachial Plexus

• The hemodynamic and hormonal basis of the hypotensive action of clonidine was investigated in tetraplegics with complete cervical spinal cord transection and preganglionic sympathetic denervation, in patients with unilateral brachial plexus injury and postganglionic sympathetic denervation, and in normal subjects [8].
• Also sensory axons label intensely with CRABP whereas motor axons do not and in the mixed nerves at the brachial plexus sensory and motor components can be distinguished on this basis [9].
• OBJECTIVE: To determine whether motor unit activation is impaired in patients with persisting disability arising from neonatal brachial plexus palsy (NBPP) [10].
• In 12 patients with traumatic lesions of brachial plexus, we studied somatosensory evoked potentials by stimulation of median, radial, and ulnar nerves at the wrist and by recording at the arm, Erb point, cervical spinal cord, and contralateral cortex [11].
• Brachial plexus neuropathy as the initial presentation of systemic lupus erythematosus [12].

Chemical compound and disease context of Brachial Plexus

• We report a case of successful bilateral brachial plexus block with ropivacaine in a patient with bilateral distal radius fracture, with each fracture requiring an open osteosynthesis [13].
• Interscalene brachial plexus block with bupivacaine and ropivacaine in patients with chronic renal failure: diaphragmatic excursion and pulmonary function changes [14].
• From evaluation of 3630 patients for possible TOS, two distinct patterns of neurologic symptoms seem apparent, that affecting the upper roots of the brachial plexus (C5, C6, and C7) and that affecting the lower roots (CS and T1) [15].
• IMPLICATIONS: This case report describes a patient who demonstrated generalized seizure activity after an injection of 30 mL of levobupivacaine 0.5% for interscalene brachial plexus block [16].
• Ablation of the brachial plexus. Control of intractable pain, due to a pathological fracture of the humerus [17].

Biological context of Brachial Plexus

• After clonidine infusion, digital skin vasodilatation occurred in normal subjects, in the innervated but not the denervated limb of patients with unilateral brachial plexus injury, and in tetraplegics, indicating that this response is due to the central sympatholytic effect of clonidine [8].
• CONCLUSION: After moderately painful orthopedic surgery of the upper extremity, ropivacaine infusion using a portable, mechanical pump and an infraclavicular brachial plexus perineural catheter at home decreased pain, sleep disturbances, narcotic use and related side effects, and improved overall satisfaction [18].
• Pharmacokinetics of ropivacaine in uremic and nonuremic patients after axillary brachial plexus block [19].
• Consequently, the authors used transcranial electrical stimulation and recorded neurogenic motor evoked potentials (MEPs) directly from the brachial plexus in a patient undergoing surgical repair of a complete upper brachial plexus injury (Erb palsy) to assess the functional continuity of motor fibers [20].
• Skin electrical resistance, measured using a simple ohm meter, has been shown to increase within 2 min of brachial plexus blockade with 1% lignocaine and adrenaline 1:200,000 [21].

Anatomical context of Brachial Plexus

• Results of this study support previous conclusions that P10 is generated in peripheral nerves (brachial plexus), P14 in medial lemniscus, N19 in sensory radiation, and P23 in sensory cortex [22].
• Specifically, we show how the expression domains of Hoxa-7, a-9 and a-10 in spinal ganglia correspond similarly in both mouse and chick with the positions of the brachial and lumbosacral plexuses, and that this is true even though the brachial plexus of chick is shifted posteriorly, relative to mouse, by seven segmental units [23].
• After median nerve stimulation, the brachial plexus volley, dorsal column volley (N11), N13, P14, N18, N20, and P22 potentials are recorded [24].
• Three of the seven AAS patients who reported brachial plexus symptoms had an ulnar nerve distribution of injury [25].
• Compressive neuropathy of the brachial plexus and long thoracic nerve: a rare complication of heparin anticoagulation [26].

Associations of Brachial Plexus with chemical compounds

• Continuous blockade of both brachial plexus with ropivacaine in phantom pain: a case report [27].
• Ropivacaine has been shown to induce successful brachial plexus anaesthesia when given at a concentration of 5 mg/ml, but not 2.5 mg/ml, and was as effective as bupivacaine in comparative studies in this indication [28].
• In studies of surgical anaesthesia in adults, levobupivacaine provided sensory block for up to 9 hours after epidural administration of < or = 202.5 mg, 6.5 hours after intrathecal 15 mg, and 17 hours after brachial plexus block with 2 mg/kg [29].
• Potent and long lasting antinociceptive effects after injection of low doses of a mu-opioid receptor agonist, fentanyl, into the brachial plexus sheath of the rat [30].
• Magnetic resonance (MR) imaging of the brachial plexus was performed in the axial, coronal, and sagittal planes in seven volunteers [31].

Gene context of Brachial Plexus

• Brachial plexus (N9, P9) and dorsal column (P11) responses were not modified by vibrations [32].
• Simultaneous GDNF and BDNF application leads to increased motoneuron survival and improved functional outcome in an experimental model for obstetric brachial plexus lesions [33].
• Potential P10 seems to originate in the brachial plexus, P12 most likely is generated in dorsal column nuclei and medial lemniscus, P14 is probably thalamic in origin but is frequently bilobed and may have a second generator source, and N19 may originate in sensory radiation or cortex [34].
• During segregation of phrenic and brachial axonal populations at the brachial plexus (E12.5-E13), PSA-NCAM expression was restricted to phrenics, being absent from brachial motoneurons [35].
• Increased N14 potential was associated with an increase in N19 and P22 potentials, and either a decrease (base) or no change (train) in the brachial plexus potential [36].

Analytical, diagnostic and therapeutic context of Brachial Plexus

• Onset times for analgesia and anesthesia in each of the C5 through T1 brachial plexus dermatomes did not differ significantly between groups [37].
• METHODS: The authors administered increasing plasma target concentrations of dexmedetomidine (0.075, 0.15, 0.3, and 0.6 ng/mL) or saline placebo to healthy young volunteers in whom the sympatholytic effects of the drug were attenuated in one of two ways: general anesthesia (propofol-alfentanil-nitrous oxide) or axillary brachial plexus block [38].
• Mean arterial pressure was lower in patients receiving isoflurane or halothane than in those receiving local anesthesia or brachial plexus blockade (BPB) [39].
• In this double-blind study, interscalene brachial plexus (ISBP) block was performed in 11 volunteers using 10 ml of either 0.25% (n = 6) or 0.5% (n = 5) bupivacaine with epinephrine 1:200,000 [40].
• In Group B, supraclavicular brachial plexus block was performed using prilocaine 1% alone, but in addition discrete nerve blocks were performed at elbow level using 0.5% bupivacaine without adrenaline [41].

References