What is the brachial plexus?
Brachial plexus (say: BRAY-kee-ul PLEX-iss) is the name given to a group of five large nerves that exit from the spinal cord between the bones of the neck (vertebrae) and provide movement and feeling to the arm.
Tension on the brachial plexus during a difficult childbirth may stretch or even pull apart one or more of five nerves. Extreme force on the plexus may rupture nerves entirely, or tear them from the spinal cord. Because of their injury, your child may have weakness in their arm or hand.
Some children are offered surgery (an operation) in an attempt to improve the movement and function in their arm. This information explains how to get your child ready for the operation and how to care for your child when you go home from the hospital.
Important information
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Getting ready for the operation
Stop giving your child ASA or ibuprofen
Starting three weeks before the operation, do not give your child ASA (acetylsalicylic acid) or ibuprofen. These medicines can thin the blood and make your child bleed too much during the operation.
Take your child to the doctor
Seven to 10 days before your child's operation, take your child to see your family doctor or paediatrician. The doctor should do a check-up to make sure your child is healthy enough to have the operation. Your surgeon's office will give you some forms for your family doctor or paediatrician to fill in. Please bring them with you on the day of your child's operation.
Call if your child has signs of illness
If your child has a fever or signs of a cold during the three days before their operation, please call your surgeon's office to let them know. Your child's surgery may need to be rescheduled.
Pack a bag for the hospital
Your child will need to stay at the hospital for three to five days after the operation. Pack a bag, including a favourite toy, clothes, pyjamas, slippers, toothbrush, toothpaste, soap, comb and other personal things you and your child will need.
Give your child a bath
Please give your child a bath and wash their hair the night before the operation.
Eating and drinking before the operation
During the operation, your child will have a special "sleep medicine" called a general anaesthetic. This will make sure that they sleep through the operation and do not feel any pain.
Your child's stomach must be empty before a general anaesthetic. If your child has even a small amount of food or drink in the stomach, your child could throw up (vomit) and damage their lungs. An empty stomach lowers the chance that your child will vomit. Follow these instructions to make sure your child's stomach is empty:
- At midnight before the operation, your child must stop eating solid food, gum, candy, milk and orange juice. Your child can still drink clear liquids, which means liquids you can see through like a window. Clear liquids include water, ginger ale and clear apple juice.
- If your baby drinks formula, stop giving formula six hours before the operation.
- If your baby is breastfeeding, stop breastfeeding your baby four hours before the operation.
- Three hours before the operation, your child must stop drinking clear liquids. Your child should not take anything by mouth until after they wake up.
If you do not follow these instructions, your child's operation will be cancelled.
Before the operation
Please arrive at the hospital two hours before your child's operation so that you can check in.
Someone will take your child to the Surgical Waiting Room. You can go with your child and wait there until it is time for the operation. Here, you will be able to talk to your child's surgeon and anaesthetist about the operation and any concerns you may have.
What happens during the brachial plexus operation
While your child is in the operating room, you may wait in the Surgical Waiting Room. Make sure that you tell the person at the desk who you are and where you are waiting. This way, we can find you if the surgeon wishes to speak to you.
Anaesthetic
The anaesthetist will give your child anaesthetic via a needle or mask to make your child sleep during the operation. The anaesthetist will also start an intravenous line (IV) by placing a small tube in a vein. Later, your child can get medicine and liquids through this tube.
What the surgeon does
During your child's operation, the surgeon will assess the nerves of the brachial plexus and determine the best form of reconstruction. Nerves from both legs are often used to replace the damaged nerves in the brachial plexus. The surgeon will make incisions (surgical cuts) along your child's neck and legs.
How long it takes
The operation will take about 12 hours. When it is over, the surgeon will come and talk to you about the operation.
After the operation
Your child will be taken to the Post-Anaesthesia Care Unit (PACU or recovery room) for about four hours. You may be able to see your child for a short time while they are there. Your child's nurse will tell you how your child is doing and what will happen. Feel free to ask questions.
Afterwards, your child will be transferred to the inpatient unit. You can go with your child.
Your child will stay in hospital for three to four days, until they are eating and feeling well.
The nurses will watch your child carefully
Your child has just had a long operation, so we will observe (watch) them carefully to make sure they are recovering well. The nurses will measure your child's vital signs often. These include heart rate, breathing, blood pressure and temperature.
If you are worried about your child for any reason, please tell your child's nurse or doctor.
Pain
Your child will get pain medicine regularly. At first, your child will get pain medicine through the IV until they can swallow the medicine as a liquid. The health care team will do everything they can to make your child comfortable.
If you think your child is still in pain, please tell your child's nurse or doctor.
Breathing
Your child may be given oxygen to help them breathe more easily. They may have their oxygen levels checked with a special machine called an oxygen saturation monitor.
Eating and drinking
Your child will get liquids through their IV until they are drinking well. Your child's first drink will be a clear fluid, such as water or sugar water. Your child can have breast milk or formula as soon as they can drink the clear fluid without throwing up (vomiting). They should be eating their usual foods within two days after the operation.
During the first 24 hours (one day) after the operation, your child may feel sick to their stomach (nauseous). This is usually not serious, but it can be upsetting for you and your child. Your nurse will comfort your child and give them medicine to make them feel better.
Movement and activity
After your child's operation, their arm will be held snugly in a soft sling. This is a piece of cloth which is put around the arm to keep it still.
Do not take off the sling. Only your child's nurse, therapist or surgeon should take off the sling. Your child will need to wear the sling for three weeks after the operation.
Your nurse will assist you in holding your child in the days after the operation.
Your physiotherapist will review what your child can and cannot do before they go home.
Dressings
Dressings are put on the areas of the neck and legs where the operation was done. A dressing is a gauze covering that protects the area of the operation. The nurse will take off your child's dressings before you go home.
Once the dressings are removed, you will be able to see the incisions (surgical cuts). Your child will have an incision on their neck and possibly three on each leg. The incisions will be covered with pieces of medical paper tape, called steri-strips. You can leave these in place until they fall off on their own.
Helping to care for your child
You and your family should help as much as you can with your child's care. Helping to care for your child in the hospital will help you feel more comfortable when you start caring for your child at home.
Caring for your child at home after the operation
You will be able to take your child home three to four days after the operation, once he is eating and feeling well. The nurses will teach you how to look after your child at home. They will give you specific instructions for your child's care.
For information about managing pain, please read Pain after an operation: Taking care of your child's pain at home.
Keep the incisions dry
Do not remove the steri-strips on your child's incisions. If they have not fallen off by the time you come back for your follow-up appointment, the clinic nurse will take them off for you. Keep the steri-strips dry.
Your child cannot have a tub bath until after their follow-up appointment. You can give your child sponge baths.
When to call the unit
Call the unit or your surgeon's office right away if you notice any signs of infection around your child's incisions. Signs of an infection include:
- fever
- redness and swelling around the incisions
- liquid coming out of the incisions
- a bad smell from the dressings
Follow-up appointment
Before you leave the hospital, you will be given an appointment to see the surgeon or the physiotherapist three weeks after your child's surgery.
What to expect after the operation
After your child's operation, you will not see results right away. It takes time for the nerves to recover.
- After the operation, your child will have less movement in the arm than before.
- It will take three to six months for the arm to get back to where it was before the operation.
- It will take six to nine months before you begin to see improvement.
- It will be up to four years before the final results are known.
Your surgeon will talk to you about what to expect.
At SickKids:
For more information about what to do before your child's operation, please contact the AboutKidsHealth Family Resource Centre at 416-813-6150.
On the day of your child's operation, please arrive at the hospital two hours before the operation. Please check in at the desk on 8C, the Plastic Surgery Unit. The Same Day Admission nurse will be expecting you. They will prepare your child for the operation and complete the paperwork.
For more information about your child's care, please call the Plastic Surgery Unit (8C) at 416-813-6932 or Dr. Clarke's office at 416-813-6444.