Peripheral Neuropathy Following Supraclavicular Brachial Plexus Block in a Patient with Recent Venomous Snake Bite: A Case Report

Background: The brachial plexus block (BPB) is commonly utilized for upper limb surgeries; however, it carries the potential risk of nerve injury. The neurotoxic properties of snake venom may exacerbate this risk. Case Presentation: A 56-year-old male patient underwent an ultrasound- and nerve stimulator-guided supraclavicular BPB for the surgical debridement of a cobra bite wound on his left forearm. The block was administered using 25 mL of 0.4% ropivacaine. Within 48 hours postoperatively, the patient exhibited significant motor weakness and sensory loss affecting the axillary, musculocutaneous, radial, and median nerves. Electromyography confirmed the presence of axonal neuropathy, while MRI ruled out mechanical trauma. The patient experienced gradual recovery over a two-month period with the aid of corticosteroids, vitamins, and physical rehabilitation. Conclusion: Pre-existing neural injury or inflammation due to snake venom may enhance the neurotoxic effects of local anesthetics. It is advisable to exercise caution when performing regional blocks in patients who have recently been envenomated.