Guidelines Summary

Guidelines from the American Society of Anesthesiologists on the prevention of perioperative peripheral nerve injury include recommendations for patient positioning, protective padding and proper placement of equipment.^[33]

Upper Extremities

To reduce the risk for perioperative injury in the upper extremities, the following specific strategies for each nerve are recommended^[33]:

Brachial plexus: If possible, arm abduction should be limited to 90° in supine patients. A prone position may allow abduction greater than 90°.

Ulnar nerve: Avoid elbow flexion

If using an armboard, position the arm with hand supination or in a neutral forearm position so as to decrease pressure on the postcondylar groove of the humerus (ulnar groove).
For supine patients, place the forearm in a neutral position.

Radial nerve: Avoid positions with prolonged pressure on the radial nerve in the spiral groove of the humerus.

Median nerve: Conduct a preoperative assessment to determine elbow range of motion. Do not extend the elbow beyond the range that is comfortable for the patient.

In addition, the following general strategies are recommended^[33]:

Assessments to ensure maintenance of the desired position should be made periodically throughout the procedure.
Padded armboards and/or padding at the elbow may be used
Chest rolls may be useful for laterally positioned patients
Ensure padding is not too tight
Ensure automated blood pressure cuffs on properly placed on the arm
If possible, avoid shoulder braces with a steep head-down position

Lower Extremities

Sciatic nerve: Conduct a preoperative assessment of extension and flexion of both the hip and the knee joints to determine the degree of hip flexion. To prevent stretching the sciatic nerve, avoid positions that stretch the hamstring muscles beyond the patient's hip flexion range of motion.

Femoral nerve: If possible, avoid extension or flexion of the hip

Peroneal nerve: Do not allow prolonged pressure on the peroneal nerve at the fibular head. Specific padding to prevent pressure of a hard surface against the peroneal nerve may be used

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Media Gallery

Peripheral nerve, cross-section. Image courtesy of the Department of Histology, Jagiellonian University Medical College.

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Author

Idan Sharon, MD Consulting Staff, Departments of Neurology and Psychiatry, Cornell New York Methodist Hospital; Private Practice

Idan Sharon, MD is a member of the following medical societies: American Academy of Neurology, Medical Society of the State of New York

Disclosure: Nothing to disclose.

Coauthor(s)

Moav Sharon

Disclosure: Nothing to disclose.

Roni Sharon, MD Neurologist, Private Practice

Roni Sharon, MD is a member of the following medical societies: American Academy of Neurology, American Headache Society, American Neurological Association, International Headache Society

Disclosure: Nothing to disclose.

Chaim I Fishfeld, DO General Surgeon, South Nassau Community Hospital

Chaim I Fishfeld, DO is a member of the following medical societies: American College of Osteopathic Surgeons, American Osteopathic Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons, International Parkinson and Movement Disorder Society, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from Abbott Neuromodulation for consulting; Received Consulting Fee from ClearPoint Neuro.

Additional Contributors

Duc Hoang Duong, MD Professor, Chief Physician, Departments of Neurological Surgery and Neuroscience, Epilepsy Center, Charles Drew University of Medicine and Science

Duc Hoang Duong, MD is a member of the following medical societies: American Neurological Association, Congress of Neurological Surgeons, North American Skull Base Society

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Caitlin Gonzalo, TO, to the development and writing of this article.

Acute Nerve Injury Guidelines

Guidelines Summary

Upper Extremities

Lower Extremities

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