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Chapter 61. Perioperative Nerve Injury Unrelated to Nerve Blockade
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Lack of pain or pressure perception due to opioids or numb extremities is a potential postoperative cause of nerve injury. Which of the following is another postoperative cause?
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A. Electrocautery thermal injuries
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C. Insertion of fixations or other sharp instruments
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B is correct. Postsurgical inflammatory neuropathy is a potential postoperative cause of nerve injury.
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A is incorrect. Electrocautery devices can lead to nerve injury but they are intraoperative causes, not postoperative causes.
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C is incorrect. Insertion of instruments and damage of nerves, the use of K-wires, and forceful use of retractors even if they are blunt are causes of intraoperative nerve damage, not postoperative causes.
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D is incorrect. Using a tourniquet can cause nerve injury, depending on the duration, the insufflation pressure, and the shape and size of the cuff. This is not a postoperative cause but a well-known intraoperative cause of nerve injury.
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A. Is an uncommon nerve injury
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B. Is due to compression, pressure, and stretch at the level of the elbow
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C. Is preventable by placing the extended forearm in pronation rather than supination during general anesthesia
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D. Resolves quickly and is not a significant source of litigation
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B is correct. Ulnar nerve injury is the most common nerve injury and leads to a significant amount of litigation. It lies in the cubital fossa, where the nerve is very superficial to the skin and encased in a bony groove, which leaves it vulnerable for compression, stretch, and pressure.
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A is incorrect. Ulnar nerve injury is the most commonly seen nerve injury.
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C is incorrect. Placing the extended forearm in supination rather than in pronation, it is possible to lessen the chances of compression of the ulnar nerve. Making sure the upper arm has a slight angle so it is not overstretched and moving the arm during very prolonged and extensive surgery can also help prevent ulnar nerve damage.
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D is incorrect. Due to the specific anatomy at the cubital fossa, the ulnar nerve is extremely vulnerable to severe neuropraxia, which can cause permanent damage and is a cause for significant litigation, as evidenced by the number of ASA closed claim cases.
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Which statement is true regarding postsurgical inflammatory neuropathy (PSIN)?
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