Chapter 61: Perioperative Nerve Injury Unrelated to Nerve Blockade

Chapter 61. Perioperative Nerve Injury Unrelated to Nerve Blockade

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?

A. Electrocautery thermal injuries

B. Inflammatory changes

C. Insertion of fixations or other sharp instruments

D. Surgical tourniquet

B is correct. Postsurgical inflammatory neuropathy is a potential postoperative cause of nerve injury.

A is incorrect. Electrocautery devices can lead to nerve injury but they are intraoperative causes, not postoperative causes.

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.

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.

Ulnar nerve injury:

A. Is an uncommon nerve injury

B. Is due to compression, pressure, and stretch at the level of the elbow

C. Is preventable by placing the extended forearm in pronation rather than supination during general anesthesia

D. Resolves quickly and is not a significant source of litigation

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.

A is incorrect. Ulnar nerve injury is the most commonly seen nerve injury.

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.

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.

Which statement is true regarding postsurgical inflammatory neuropathy (PSIN)?