Brachial Plexus Block Following Serratus Anterior Plane Block After Minimally Invasive Cardiac Surgery Identified Using Contrast X-Ray - A Case Report

Sep 29, 2026

A serratus anterior plane block (SAPB) is effective for postoperative pain management after minimally invasive cardiac surgery (MICS), though rare complications can occur. This case report describes a 74-year-old woman who developed right upper limb neurological symptoms after continuous SAPB administered following mini-thoracotomy aortic valve replacement. Contrast-enhanced X-ray demonstrated atypical catheter-related spread. Reduced grip strength and sensory deficits resolved after stopping programmed intermittent bolus infusion, and clinical course suggested catheter tip migration within the serratus anterior muscle layers.

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Introduction

Case Presentation

Wiley Case Reports in Anesthesiology Volume 2026, Article ID 9755915, 4 pages [https://doi.org/10.1155/cria/9755915](https://doi.org/10.1155/cria/9755915) Case Report Brachial Plexus Block Following Serratus Anterior Plane Block After Minimally Invasive Cardiac Surgery Identified Using Contrast X-Ray: A Case Report Yuna Sato , 1 Michio Kumagai,2 Yusuke Takei,1 Kazutomo Saito, 1 Takahiro Tasaki,3 and Masanori Yamauchi1 1 Department of Anesthesiology and Perioperative Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan 2 Division of Anesthesia, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan 3 Department of Anesthesiology, Sendai Kousei Hospital, Sendai, Japan Correspondence should be addressed to Yuna Sato; [yuna.sato.c5@tohoku.ac.jp](yuna.sato.c5@tohoku.ac.jp) Received 16 September 2025; Revised 15 December 2025; Accepted 26 December 2025 Academic Editor: Manzo Suzuki Copyright © 2026 Yuna Sato et al. Case Reports in Anesthesiology published by John Wiley & Sons Ltd. Tis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. A serratus anterior plane block is efective for pain management after minimally invasive cardiac surgery (MICS) but may cause rare complications. In this study, we present a case of upper limb neurological symptoms following a serratus anterior plane block (SAPB) administered after MICS, which was visualized via contrast x-ray imaging. A 74-year-old woman with severe aortic stenosis underwent aortic valve replacement via minithoracotomy. We preoperatively inserted a SAPB catheter deep into the serratus anterior muscle (SAM) . Postoperative x-ray imaging with contrast medium revealed its distribution extending from the chest wall (second to fourth ribs), detached from the thorax, toward the right upper arm. We initiated a programmed intermittent bolus infusion (PIBI) via the catheter, but the patient developed reduced grip and sensory defcits in the right arm. Discontinuation of PIBI on postoperative day fve led to neurological symptom resolution by day six. Te clinical course and contrast distribution suggested that the catheter tip may have migrated to the superfcial layer of the SAM. Tese fndings highlight the importance of confrming catheter placement and carefully monitoring neurological symptoms when atypical contrast spread patterns are observed. Keywords: brachial plexus block; case report; minimally invasive cardiac surgery; peripheral nerve block; serratus anterior plane block 1. Introduction Minimally invasive cardiac surgery (MICS) typically involves a small lateral thoracotomy and is associated with fewer complications than traditional medial sternotomy [1] . Nevertheless, damage to the thoracic wall muscles, ribs, or intercostal nerves may result in post-MICS pain [2] . Serratus anterior plane block (SAPB) has the potential to improve post-MICS pain management by blocking the lateral cutaneous branches of the intercostal nerves, which innervate the lateral chest wall [3] . Although the efectiveness of continuous SAPB in post-MICS analgesia has been demonstrated, reports on block-related complications remain limited [4–6] . Herein, we report a rare and educational case of upper extremity neurological symptoms, presumed to be related to continuous SAPB for post-MICS analgesia, with contrastenhanced radiography aiding in the diagnosis. 2. Case Presentation A 74-year-old woman (height: 150 cm and weight: 43 kg) with severe aortic stenosis (AS) underwent MICS with aortic valve replacement (AVR) via a right-sided 2 Case Reports in Anesthesiology Figure 1: Postoperative frontal and lateral chest radiographs showing contrast medium spreading from the serratus anterior plane block catheter. Te contrast medium (yellow arrow) is seen extending from the chest wall (second to fourth ribs), detache

FAQs

What complication occurred after serratus anterior plane block following minimally invasive cardiac surgery?

The patient developed upper limb neurological symptoms, including reduced grip strength and sensory deficits in the right arm.

How was the catheter placement and contrast spread assessed in this case?

Postoperative contrast-enhanced X-ray imaging visualized the distribution pattern extending toward the right upper arm, helping infer catheter tip migration.

What treatment led to symptom resolution?

Stopping the programmed intermittent bolus infusion on postoperative day 5 led to resolution of neurological symptoms by day 6.

Sep 29, 2026

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