What is the maximum recommended arm abduction to avoid brachial plexus injury during a laparoscopic procedure?

What is the maximum recommended arm abduction to avoid brachial plexus injury during a laparoscopic procedure?

• A. Do not abduct >60 degrees
• B. Do not abduct >120 degrees
• C. Do not abduct >90 degrees (correct)
• D. Abduct to 180 degrees

Answer: (C)

Limiting how far the arm is abducted during laparoscopy helps prevent traction on the brachial plexus as it travels from the neck into the arm. When the arm is raised to about 90 degrees or more, the neural elements can be stretched against the clavicle and first rib, increasing the risk of neuropraxia during a lengthy procedure. Keeping abduction to around 90 degrees reduces this traction while still allowing enough access for the operation. Abducting further (toward 120 or 180 degrees) would increase the stretch and risk, whereas staying below 90 degrees minimizes nerve tension. In practice, position the arms with support to about 90 degrees of abduction, ensure adequate padding, and avoid neck extension or extreme rotation to protect the brachial plexus.

Limiting how far the arm is abducted during laparoscopy helps prevent traction on the brachial plexus as it travels from the neck into the arm. When the arm is raised to about 90 degrees or more, the neural elements can be stretched against the clavicle and first rib, increasing the risk of neuropraxia during a lengthy procedure. Keeping abduction to around 90 degrees reduces this traction while still allowing enough access for the operation. Abducting further (toward 120 or 180 degrees) would increase the stretch and risk, whereas staying below 90 degrees minimizes nerve tension. In practice, position the arms with support to about 90 degrees of abduction, ensure adequate padding, and avoid neck extension or extreme rotation to protect the brachial plexus.