Post-Operative Neuropathy
Peripheral nerve injury is:
- One of the most common anaesthetic complications
- Caused by a number of factors
- Poor patient position
Leads to:- Stretching of the nerve
- External compression
- Poor patient position
Epidemiology and Risk Factors
Risk factors include:
- Male
70%. - Prolonged hospital stay
- Obesity
- DM
- Age
Clinical Manifestations
- Typically is not evident in recovery
- May take 24 hours to become apparent
- 90% of cases present within 7 days
- 47% sensory
- 25% involve ulnar nerve compression
Management
Management is primarily preventative:
- Keep the arms by the side if possible
- Avoid >90° bend at elbow and shoulder
- Rotate the head towards the abducted upper limb to reduce brachial plexus traction
- Supinate the upper limb to prevent ulnar nerve compression
- Avoid direct pressure in the axilla and shoulder
- Place pads under bony prominences
- Avoid rapid movement of the shoulder to prevent rotator cuff injury
Prognosis
- 53% of patients recover within one year
- Pure sensory loss has a better prognosis
- ~25% have persistent pain
References
- Feix B, Sturgess J. Anaesthesia in the prone position. Continuing Education in Anaesthesia Critical Care & Pain. 2014 Dec. Pages 291–297.
- Knight DJW, Mahajan RP. Patient positioning in anaesthesia. Continuing Education in Anaesthesia Critical Care & Pain. Oct 2004.