DOI: 10.1097/01.sa.0000140556.23966.a6
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Issn Print: 0039-6206
Publication Date: 2004/10/01
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Excerpt
(J Neurosurg Anesthesiol, 16:84-86, 2004)
Department of Anesthesiology, Hospital for Special Surgery, New York, NY.
Nerve injuries have been described as clinical, anatomic, or laboratory findings consistent with damage to discrete elements of the peripheral nervous system. This rather broad definition of nerve injury underscores that not all 3 characteristics need occur simultaneously or in combination. Indeed, the significance of a nerve injury depends on the quality and severity of the sensory or motor deficit, the duration of the clinical symptoms, and the patient in whom the injury occurs. For example, what might be a minor nuisance to one individual might be a catastrophe to a professional musician.
A wide range in the incidence of nerve injury has been reported. However, the closer investigators look, the more frequently problems are encountered. Timing of follow-up is also important. Nonetheless, it appears that most injuries are temporary and involve minor dysesthesias and paresthesias, or mild pain.
Nerve injury after surgery performed under regional blocks may be the result of several potential factors including direct trauma from the needle, local anesthetic neurotoxicity, ischemia secondary to pressure and volume of local anesthetic or vasoconstrictors, hematoma or vascular injury, intraoperative factors such as surgical trauma and positioning, tourniquet injury, and postoperative factors. Several animal studies evaluating the role of bevel and needle orientation have disclosed that, while the frequency of injury is greater with long beveled needles, the duration and severity of injury are greater with short beveled needles. Nerve injury also seems to be less severe when the bevel orientation is kept parallel, rather than perpendicular, to nerve fibers.
