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Bilateral transient radial nerve palsies in an infant after cardiac surgery

Nobuaki Shime, MD PhD^*, Yuko Kato, MD^*, Yoshifumi Tanaka, MD PhD^* and Wook-Cheol Kim, MD PhD

^* From the Department of Anesthesiology and Intensive Care,
and Department of Orthopedics, Kyoto Prefectural University of Medicine, Kyoto, Japan.

Address correspondence to: Dr. Nobuaki Shime, Department of Anesthesiology and Intensive Care, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, Japan. Phone: +81-75-251-5633; Fax: +81-75-251-5843; E-mail: shime{at}koto.kpu-m.ac.jp

Purpose: To describe the case of an infant who suffered bilateral transient radial nerve palsies after cardiac surgery.

Clinical features: A one-month-old baby was found to have bilateral wrist and finger drop after the removal of splints that has been applied to the right hand for 14 days and to the right hand for six days during perioperative management of Blalock-Taussig shunt surgery. The hand splints had been applied to the forearms with adhesive silky tape to keep peripheral vascular lines in place. The patient also suffered from several episodes of cardiogenic shock, hypoxemia and generalized edema relating to cardiac dysfunction during this fine period. Given the findings of no impairment of median or ulnar nerves and brachioradial muscle, it was suspected that bandaging with adhesive tapes caused peripheral radial nerve damage at the level of posterior interosseus nerve on forearm. Diminished oxygen delivery and edema may additionally have contributed to peripheral nerve ischemia. The aforementioned neurologic symptoms resolved spontaneously after several days.

Conclusion: Prolonged compression by bandaging of splints on forearm may have resulted in ischemic damage to the posterior interosseus nerve branch combined with extensor carpi radialis longus nerve branch of the radial nerve. We should attempt to reduce the frequency and duration of splinting of the extremities, especially in sedated, paralyzed babies, given the potential risk of compression neuropathy.