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Neurologic Evaluation and Management of Perioperative Nerve Injury
  1. James C. Watson, MD*,† and
  2. Marc A. Huntoon, MD‡
  1. From the Departments of *Neurology, and †Anesthesiology, Pain Division, Mayo Clinic, Rochester, MN; and ‡Department of Anesthesiology, Division of Pain Medicine, Vanderbilt University, Nashville, TN
  1. Address correspondence to: James C. Watson, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (e-mail: Watson.james{at}mayo.edu).

Abstract

Neurologic injury after regional anesthesia or pain medicine procedures is rare. Postprocedural neurologic deficits may create high levels of anxiety for the patient and practitioner, although most deficits are limited in severity and can be expected to fully resolve with time. Postoperative anesthesia–related neuraxial and peripheral nerve injuries are reviewed to define an efficient, structured approach to these complications. Emphasis is placed on acutely stratifying the urgency and scope of diagnostic testing or consultation necessity, initiating appropriate definitive treatments, and defining appropriate out-of-hospital follow-up and symptom management.

What’s New Studies pertinent to the recognition, evaluation, and treatment of neurologic assessment of perioperative nerve injury and published since the last advisory on the topic1 are reviewed and a new structured algorithmic approach is proposed. The evolving literature on postoperative inflammatory neuropathies is reviewed to help define the clinical criteria and to identify patients who would benefit from early neurological evaluation. New sections review potential acute interventions to improve neurologic outcome and long-term management of neuropathic pain resulting from perioperative nerve injury.

https://doi.org/10.1097/AAP.0000000000000185

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    Footnotes

    • The authors declare no conflict of interest.

      Presented at the Annual Meeting of the American Society of Regional Anesthesia and Pain Medicine, March 16, 2012, San Diego, CA.