Prevention of Perioperative Peripheral Neuropathies
Publication Date: January 1, 2018
Summary of Advisory Recommendations
Preoperative History and Physical Assessment
Review a patient’s preoperative history and perform a physical examination to identify: body habitus, preexisting neurologic symptoms, diabetes mellitus, peripheral vascular disease, alcohol dependency, arthritis, and sex (e.g., male sex and its association with ulnar neuropathy). When judged appropriate, ascertain whether patients can comfortably tolerate the anticipated operative position.
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Positioning Strategies for the Upper Extremities
Positioning Strategies to Reduce Perioperative Brachial Plexus Neuropathy
When possible, limit arm abduction in a supine patient to 90°.
- The prone position may allow patients to comfortably tolerate abduction of their arms to greater than 90°.
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Positioning Strategies to Reduce Perioperative Ulnar Neuropathy
Supine Patient with Arm on an Armboard: Position the upper extremity to decrease pressure on the postcondylar groove of the humerus (ulnar groove).
- Use of either supination or the neutral forearm positions may be used to facilitate this action.
Supine Patient with Arms Tucked at Side: Place the forearm in a neutral position.
Flexion of the Elbow: When possible, avoid flexion of the elbow to decrease the risk of ulnar neuropathy.
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Positioning Strategies to Reduce Perioperative Radial Neuropathy
Avoid prolonged pressure on the radial nerve in the spiral groove of the humerus.
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Positioning Strategies to Reduce Perioperative Median Neuropathy
Avoid extension of the elbow beyond the range that is comfortable during the preoperative assessment to prevent stretching of the median nerve.
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Periodic Assessment of Upper Extremity Position during Procedures
Periodic perioperative assessments may be performed to ensure maintenance of the desired position.
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Positioning Strategies for the Lower Extremities
Positioning Strategies to Reduce Perioperative Sciatic Neuropathy
Stretching of the Hamstring Muscle Group: Positions that stretch the hamstring muscle group beyond the range that is comfortable during the preoperative assessment may be avoided to prevent stretching of the sciatic nerve Limiting Hip Flexion: Since the sciatic nerve or its branches cross both the hip and the knee joints, assess extension and flexion of these joints when determining the degree of hip flexion.
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Positioning Strategies to Reduce Perioperative Femoral Neuropathy
When possible, avoid extension or flexion of the hip to decrease the risk of femoral neuropathy.
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Positioning Strategies to Reduce Perioperative Peroneal Neuropathy
Avoid prolonged pressure on the peroneal nerve at the fibular head.
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Protective Padding
Padded armboards may be used to decrease the risk of upper extremity neuropathy. Chest rolls in the laterally positioned patient may be used to decrease the risk of upper extremity neuropathy. Padding at the elbow may be used to decrease the risk of upper extremity neuropathy. Specific padding to prevent pressure of a hard surface against the peroneal nerve at the fibular head may be used to decrease the risk of peroneal neuropathy. Avoid the inappropriate use of padding (e.g., padding too tight) to decrease the risk of perioperative neuropathy.
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Equipment
When possible, avoid the improper use of automated blood pressure cuffs on the arm (i.e., placed below the antecubital fossa) to reduce the risk of upper extremity neuropathy. When possible, avoid the use of shoulder braces in a steep head-down position to decrease the risk of perioperative neuropathies.
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Postoperative Physical Assessment
Perform a simple postoperative assessment of extremity nerve function for early recognition of peripheral neuropathies.
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Documentation
Document specific perioperative positioning actions that may be useful for continuous improvement processes.
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Title
Prevention of Perioperative Peripheral Neuropathies
Authoring Organization
American Society of Anesthesiologists
Publication Month/Year
January 1, 2018
External Publication Status
Published
Country of Publication
US
Document Objectives
Educate ASA members, provide a reference framework for individual practices, and stimulate the pursuit and evaluation of strategies that may prevent or reduce the frequency of occurrence or minimize the severity of peripheral neuropathies that may be related to perioperative positioning of patients.
Target Patient Population
Adult patients who are or have been sedated or anesthetized
Target Provider Population
Anesthesiologists
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Hospital, Operating and recovery room, Outpatient
Intended Users
Medical assistant, nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Prevention, Management
Diseases/Conditions (MeSH)
D009477 - Hereditary Sensory and Autonomic Neuropathies
Keywords
Anesthesiology, Perioperative Peripheral Neuropathies, Neuropathies
Source Citation
Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies 2018: An Updated Report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies*. Anesthesiology 2018;128(1):11-26.
Methodology
Number of Source Documents
77
Literature Search Start Date
January 1, 1999
Literature Search End Date
July 31, 2017