What Actions Can Be Used to Prevent Peripheral Nerve Injury?

Perioperative peripheral nerve injury is a significant source of morbidity for patients and a frequent cause of professional liability for anesthesiologists. The etiology of perioperative nerve injury is largely unknown and multifactorial, and insults interact with the patient’s underlying neuronal reserve. There are few prospective studies on the genesis or prevention of perioperative neuropathy. This chapter summarizes the evidence related to the etiology and incidence of perioperative upper and lower extremity peripheral nerve injury. It also summarizes evidence related to nerve injury after peripheral nerve blockade. Because of the absence of randomized controlled trials and a paucity of epidemiologic studies, the evidence on which practice patterns for prevention of perioperative peripheral neuropathy are based is largely consensus opinion. The chapter summarizes the recommendations from the 2018 American Society of Anesthesiologists (ASA) Task Force on Prevention of Perioperative Peripheral Neuropathies concerning perioperative positioning of the patient, use of protective padding, and avoidance of contact with hard surfaces or supports to reduce perioperative neuropathies.