Materiały źródłowe

• #1 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #2 Postpartum Peripheral Nerve Injuries – What is Anesthesia’s Role? – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/postpartum-peripheral-nerve-injuries-what-is-anesthesias-role/

  Postpartum peripheral nerve injuries occur in approximately 0.3–2% of all deliveries. […] It is important that anesthesia professionals create systems to identify women who have experienced postpartum lower extremity nerve injuries and connect patients with resources. […] Anesthesia professionals should work with the obstetricians and nurses at their institution to ensure that all patients are evaluated after delivery and asked about symptoms consistent with postpartum lower extremity nerve injuries. […] If a nerve injury is detected, the nerve(s) affected should be identified, and the injury described in the medical record (motor, sensory, or mixed). […] The patient should also be evaluated by physical therapy or physiatry to ensure that the patient is safe to ambulate with her infant prior to discharge from the hospital.

• #3

  https://www.scielo.br/j/anp/a/pxWRK8YRSxN9pX4ZG8LwTRw/

  Acute peripheral nerve injuries are one of the complications of trauma affecting the extremities, and is present in 310% of patients, depending on the mechanism of trauma. These traumatic injuries are a significant cause of physical disability that affects mainly young adults of working age. Although some nerve injuries recover spontaneously, in some cases surgery is the only therapeutic option for the improvement of neurological deficits or control of neuropathic pain. Indications for surgery in patients with peripheral nerve injury depends on several variables including mechanism of injury, interval between injury and treatment, lesion severity, findings of the clinical examination, and intensity of neuropathic pain. […] In this article we review the classification, mechanisms and evaluation of peripheral nerve injuries, with emphasis on indications for surgical treatment.

• #4 Preventing perioperative peripheral nerve injuries – PubMed

  https://pubmed.ncbi.nlm.nih.gov/23265653/

  Peripheral nerve injuries are largely preventable injuries that can result from incorrect patient positioning during surgery. […] Careful attention to body alignment and proper padding of bony prominences when positioning patients for surgery is necessary to prevent peripheral nerve injury. […] The use of a preoperative assessment tool to identify at-risk patients, collaboration between physical therapy and OR staff members regarding patient positioning, and neurophysiological monitoring can help prevent peripheral nerve injuries.

• #5 Peripheral nerve injuries in athletes. Treatment and prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8378668/

  Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete’s safe return to sports. […] Proper equipment, technique and conditioning are the keys to prevention. […] Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment.

• #6 Nerve Pain and Nerve Damage: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/brain/nerve-pain-and-nerve-damage-symptoms-and-causes

  Prevent your overall risk of having nerve pain by living a healthy lifestyle, such as not smoking, exercising regularly, eating healthy foods, and limiting your alcohol use. […] See your doctor regularly for checkups and share any concerns you may have about early signs of nerve pain.

• #7 Peripheral Neuropathy | MedlinePlus

  https://medlineplus.gov/peripheralnervedisorders.html

  You can help prevent peripheral nerve disorders by: […] Managing health conditions that may cause nerve damage, especially diabetes […] Preventing falls and accidents […] Avoiding toxic substances […] Being careful to avoid repeated motions and body positions that press on your nerves […] Eating a balanced diet, exercising, limiting alcohol, and not smoking.

• #8 Peripheral Neuropathy: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy

  Some of the possible causes of peripheral neuropathy are preventable. You can also lower your chances of developing it by preventing or delaying certain conditions. In general, the best preventive or precautionary steps you can take include: […] Wearing safety equipment as needed. Injuries are a major source of nerve damage. Using safety equipment during work and play activities can protect you from these injuries or limit how severe the injuries are. […] Managing chronic conditions as recommended. If you have a chronic condition that can affect your peripheral nerves, especially type 2 diabetes, it’s important to manage it as your healthcare provider recommends. That can limit the effects of the condition or delay how long it takes to get worse. […] Avoiding alcohol in excess. Excessive consumption of alcohol is a proven cause of peripheral neuropathy. You can reduce your risk of neuropathy (and some other medical complications) by avoiding alcohol, or consuming it in moderation only. […] Avoiding exposures to toxins, poisons and heavy metals. Heavy metals like lead and mercury can cause severe damage to your nervous system.

• #9 Peripheral nerve injuries – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/symptoms-causes/syc-20355631

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] If you experience weakness, tingling, numbness or a total loss of feeling, see your healthcare professional to find out the cause. It’s important to treat peripheral nerve injuries early. […] People who experience physical trauma or play sports may be at higher risk of an injury that can stretch or crush peripheral nerves. People with certain medical conditions also may be at higher risk of peripheral nerve injuries. These conditions, especially diabetes, may put nerves at greater risk of compression.

• #10 Peripheral Neuropathy: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy

  Some of the possible causes of peripheral neuropathy are preventable. You can also lower your chances of developing it by preventing or delaying certain conditions. In general, the best preventive or precautionary steps you can take include: […] Wearing safety equipment as needed. Injuries are a major source of nerve damage. Using safety equipment during work and play activities can protect you from these injuries or limit how severe the injuries are. […] Managing chronic conditions as recommended. If you have a chronic condition that can affect your peripheral nerves, especially type 2 diabetes, it’s important to manage it as your healthcare provider recommends. That can limit the effects of the condition or delay how long it takes to get worse. […] Avoiding alcohol in excess. Excessive consumption of alcohol is a proven cause of peripheral neuropathy. You can reduce your risk of neuropathy (and some other medical complications) by avoiding alcohol, or consuming it in moderation only. […] Avoiding exposures to toxins, poisons and heavy metals. Heavy metals like lead and mercury can cause severe damage to your nervous system.

• #11 Peripheral Neuropathy | MedlinePlus

  https://medlineplus.gov/peripheralnervedisorders.html

  You can help prevent peripheral nerve disorders by: […] Managing health conditions that may cause nerve damage, especially diabetes […] Preventing falls and accidents […] Avoiding toxic substances […] Being careful to avoid repeated motions and body positions that press on your nerves […] Eating a balanced diet, exercising, limiting alcohol, and not smoking.

• #12 Peripheral Neuropathy: What It Is, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/14737-peripheral-neuropathy

  Some of the possible causes of peripheral neuropathy are preventable. You can also lower your chances of developing it by preventing or delaying certain conditions. In general, the best preventive or precautionary steps you can take include: […] Wearing safety equipment as needed. Injuries are a major source of nerve damage. Using safety equipment during work and play activities can protect you from these injuries or limit how severe the injuries are. […] Managing chronic conditions as recommended. If you have a chronic condition that can affect your peripheral nerves, especially type 2 diabetes, it’s important to manage it as your healthcare provider recommends. That can limit the effects of the condition or delay how long it takes to get worse. […] Avoiding alcohol in excess. Excessive consumption of alcohol is a proven cause of peripheral neuropathy. You can reduce your risk of neuropathy (and some other medical complications) by avoiding alcohol, or consuming it in moderation only. […] Avoiding exposures to toxins, poisons and heavy metals. Heavy metals like lead and mercury can cause severe damage to your nervous system.

• #13 Peripheral nerve injuries in athletes. Treatment and prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8378668/

  Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete’s safe return to sports. […] Proper equipment, technique and conditioning are the keys to prevention. […] Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment.

• #14 Nerve Pain and Nerve Damage: Symptoms, Causes, Diagnosis, and Treatment

  https://www.webmd.com/brain/nerve-pain-and-nerve-damage-symptoms-and-causes

  Prevent your overall risk of having nerve pain by living a healthy lifestyle, such as not smoking, exercising regularly, eating healthy foods, and limiting your alcohol use. […] See your doctor regularly for checkups and share any concerns you may have about early signs of nerve pain.

• #15 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #16 What Actions Can Be Used to Prevent Peripheral Nerve Injury? | Anesthesia Key

  https://aneskey.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  What Actions Can Be Used to Prevent Peripheral Nerve Injury? […] 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 ASA Task Force on Prevention of Perioperative Peripheral Neuropathies formed guidelines regarding perioperative positioning of the patient, use of protective padding, and avoidance of contact with hard surfaces or supports to reduce perioperative neuropathies. […] Padded arm boards may decrease the risk of upper extremity neuropathy. […] The use of chest rolls in the laterally positioned patient may decrease the risk of upper extremity neuropathy. […] Padding at the elbow may decrease the risk of upper extremity neuropathy.

• #17 What Actions Can Be Used to Prevent Peripheral Nerve Injury? – Clinical Tree

  https://clinicalpub.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  Perioperative peripheral nerve injury is a significant source of morbidity for patients, and the second most frequent cause of professional liability for anesthesiologists, accounting for 12% of general anesthesia malpractice claims since 1990 according to the Anesthesia Closed Claims Database, funded by the Anesthesia Quality Institute, the quality wing of the American Society of Anesthesiologists (ASA). […] The ASA Task Force on Prevention of Perioperative Peripheral Neuropathies formed a practice advisory regarding perioperative positioning of the patient, use of protective padding, and avoidance of contact with hard surfaces or supports to reduce perioperative neuropathies published in 2018. […] Even with close adherence to these recommendations, however, many peripheral neuropathies, especially those involving the ulnar nerve, may not be preventable.

• #18 Patient Safety Tip of the Week Archive

  https://www.patientsafetysolutions.com/docs/January_2_2018_Preventing_Perioperative_Nerve_Injuries.htm

  The American Society of Anesthesiologists just published its 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. (ASA 2018). This is an update to the 2011 Advisory we have discussed before. The Advisory reviews the literature on perioperative nerve injuries and grades the evidence, solicits opinions from consultants with expertise on the topic, and also provides results of surveys of anesthesiologists. Key elements from the update are listed below. […] The preoperative history and physical should focus on risk factors for nerve damage including: 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). It should also ascertain whether patients can comfortably tolerate the anticipated operative position.

• #19 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #20 Peripheral Nerve Injuries and Positioning for General Anaesthesia : Virtual Library

  https://resources.wfsahq.org/atotw/peripheral-nerve-injuries-and-positioning-for-general-anaesthesia/

  Peripheral nerve injuries are often related to positioning of the patient and to the surgical procedure. […] Attention to minimising risk factors can decrease the incidence of nerve insult. […] Final positioning should be carefully assessed before draping commences. […] Good documentation of anaesthetic care includes specific information on positioning, including stating when padding has been used. […] The aim of surgical positioning is to allow good surgical access while minimising risk of harm to the patient. […] Safe patient positioning includes ensuring that; The patient is secure on the operating table, All limbs are placed in natural positions without stretch to nerves/muscles/tendons/vessels, All pressure areas are padded and eyes are protected. […] Peripheral nerve injuries are often related to positioning of the patient and to the surgical procedure.

• #21 What Actions Can Be Used to Prevent Peripheral Nerve Injury? | Anesthesia Key

  https://aneskey.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  The use of specific padding to prevent pressure of a hard surface against the peroneal nerve at the fibular head may decrease the risk of peroneal neuropathy. […] The inappropriate use of padding (e.g., padding too tight) may increase the risk of perioperative neuropathy. […] The ASA Task Force on Prevention of Perioperative Peripheral Neuropathies concluded that arm abduction should be limited to 90 degrees in supine patients. […] The ASA Task Force on Prevention of Perioperative Peripheral Neuropathies concurred that shoulder braces in a steep head-down position may increase the risk of brachial plexus neuropathies. […] The ASA Task Force on Prevention of Perioperative Peripheral Neuropathies recommended use of chest rolls in laterally positioned patients to reduce the risk of upper extremity neuropathies.

• #22 What Actions Can Be Used to Prevent Peripheral Nerve Injury? | Anesthesia Key

  https://aneskey.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  The ASA Task Force on Prevention of Perioperative Peripheral Neuropathies concluded that extension of the elbow beyond a comfortable range may stretch the median nerve. […] The ASA Task Force on Prevention of Perioperative Peripheral Neuropathies concluded that flexion of the elbow may increase the risk of ulnar neuropathy, but the acceptable degree of elbow flexion remains unclear.

• #23

  https://journals.lww.com/neur/fulltext/2019/67001/iatrogenic_peripheral_nerve_injuries.29.aspx

  Recommendations to reduce the risk of perioperative ulnar nerve injury include avoidance of full elbow extension with forearm pronated, avoidance of 90 elbow flexion and 90 shoulder abduction, and placement of a non-invasive blood pressure cuff so that it does not compromise the cubital tunnel above the elbow. […] The treatment options include an early neurolysis, a delayed exploration with neurolysis, or resection and anastomosis. […] The significance of preoperative counselling regarding the potential likelihood of injury and the accurate documentation of intraoperative and postoperative findings cannot be overemphasized.

• #24 What Actions Can Be Used to Prevent Peripheral Nerve Injury? | Anesthesia Key

  https://aneskey.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  What Actions Can Be Used to Prevent Peripheral Nerve Injury? […] 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 ASA Task Force on Prevention of Perioperative Peripheral Neuropathies formed guidelines regarding perioperative positioning of the patient, use of protective padding, and avoidance of contact with hard surfaces or supports to reduce perioperative neuropathies. […] Padded arm boards may decrease the risk of upper extremity neuropathy. […] The use of chest rolls in the laterally positioned patient may decrease the risk of upper extremity neuropathy. […] Padding at the elbow may decrease the risk of upper extremity neuropathy.

• #25 What Actions Can Be Used to Prevent Peripheral Nerve Injury? – Clinical Tree

  https://clinicalpub.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  Padded armboards may be used to decrease the risk for 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. […] 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.

• #26 What Actions Can Be Used to Prevent Peripheral Nerve Injury? – Clinical Tree

  https://clinicalpub.com/what-actions-can-be-used-to-prevent-peripheral-nerve-injury/

  Padded armboards may be used to decrease the risk for 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. […] 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.

• #27

  https://journals.lww.com/neur/fulltext/2019/67001/iatrogenic_peripheral_nerve_injuries.29.aspx

  Recommendations to reduce the risk of perioperative ulnar nerve injury include avoidance of full elbow extension with forearm pronated, avoidance of 90 elbow flexion and 90 shoulder abduction, and placement of a non-invasive blood pressure cuff so that it does not compromise the cubital tunnel above the elbow. […] The treatment options include an early neurolysis, a delayed exploration with neurolysis, or resection and anastomosis. […] The significance of preoperative counselling regarding the potential likelihood of injury and the accurate documentation of intraoperative and postoperative findings cannot be overemphasized.

• #28 Patient Safety Tip of the Week Archive

  https://www.patientsafetysolutions.com/docs/January_2_2018_Preventing_Perioperative_Nerve_Injuries.htm

  It then focuses on limb positioning issues, first describing vulnerable positions identified from the literature and then making recommendations for positioning to avoid injury to various peripheral nerves. The Advisory has recommendations on positioning to reduce the likelihood of injuries to specific nerves (we refer you to the actual document for details): […] The Advisory does recommend that periodic perioperative assessments may be performed to ensure maintenance of the desired position. […] It makes recommendations about the use of protective padding: […] And recommendations about other equipment: […] We agree with Duffy and Tubog that everyone on the surgical team has an important role in preventing perioperative nerve injuries. Having a good understanding of the risk factors, vulnerable anatomical positions, preventive measures, and monitoring is critical to minimize the risk of such injuries. We hope all involved in surgery will read the two new papers and heed the recommendations therein and also consider the use of electrophysiologic monitoring at least in patients deemed to be at high risk for perioperative nerve injury.

• #29 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #30 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #31 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #32 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #33 Peripheral Nerve Injuries from Positioning – OpenAnesthesia

  https://www.openanesthesia.org/keywords/peripheral-nerve-injuries-from-positioning/

  The incidence of peripheral nerve injury (PNI) after general anesthesia is less than 1% but represents approximately 22% of general anesthesia malpractice claims from 1990-2007. […] Constant vigilance is important during the preoperative and intraoperative stages of anesthesia to decrease the risk of development of perioperative PNI. […] A focused preoperative history should be obtained to identify patients at an increased risk. […] Proper patient positioning is critical to prevent PNIs. […] Padding the elbow too tightly can paradoxically cause injury. The goal of padding is to distribute weight over as wide an area as possible. […] Continual nerve monitoring in selected high-risk patients and procedures should be considered. […] A thorough postoperative assessment (a full history and exam) is important for early recognition of PNI. […] Proper documentation of findings and early neurologist evaluation is imperative. […] Key diagnostic tests: Nerve conduction studies (NCS) and needle electromyography can confirm diagnosis, localize injury, classify degree, predict prognosis, and may direct surgical intervention.

• #34 Peripheral nerve injuries in athletes. Treatment and prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8378668/

  Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete’s safe return to sports. […] Proper equipment, technique and conditioning are the keys to prevention. […] Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment.

• #35

  https://link.springer.com/article/10.2165/00007256-199316020-00005

  Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athletes safe return to sports. […] Proper equipment, technique and conditioning are the keys to prevention. […] Prophylactic measures are only modestly successful. […] However, early recognition and treatment are vital to prevent associated morbidity of these rare but serious injuries.

• #36

  https://link.springer.com/article/10.2165/00007256-199316020-00005

  Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athletes safe return to sports. […] Proper equipment, technique and conditioning are the keys to prevention. […] Prophylactic measures are only modestly successful. […] However, early recognition and treatment are vital to prevent associated morbidity of these rare but serious injuries.

• #37

  https://link.springer.com/article/10.1007/s11916-024-01268-w

  Postoperative nerve injury after nerve block is complex and multifactorial. […] This review article conducts a literature search and summarizes current evidence and best practices in prevention of nerve injury. […] Studies show avoidance of intrafascicular injection, limiting concentrations/volumes of local anesthetic, and appropriate patient selection are the most significant controllable factors in limiting the negative consequences of nerve block. […] Prevention of nerve injury by surgical teams, care with positioning, and avoidance of intrafascicular injection with nerve block are the most evidence-based practices. […] True anesthetic consideration would be to avoid intrafascicular injection to reduce neurotoxic axonal injury secondary to local anesthetic exposure. […] While engaging in nerve block, the few things within the operator purview are to minimize possibility of intrafascicular injection or needle placement and to utilize a short bevel needle. […] This may be done by monitoring of evoked motor response at thresholds below 0.5.

• #38

  https://link.springer.com/article/10.1007/s11916-024-01268-w

  Postoperative nerve injury after nerve block is complex and multifactorial. […] This review article conducts a literature search and summarizes current evidence and best practices in prevention of nerve injury. […] Studies show avoidance of intrafascicular injection, limiting concentrations/volumes of local anesthetic, and appropriate patient selection are the most significant controllable factors in limiting the negative consequences of nerve block. […] Prevention of nerve injury by surgical teams, care with positioning, and avoidance of intrafascicular injection with nerve block are the most evidence-based practices. […] True anesthetic consideration would be to avoid intrafascicular injection to reduce neurotoxic axonal injury secondary to local anesthetic exposure. […] While engaging in nerve block, the few things within the operator purview are to minimize possibility of intrafascicular injection or needle placement and to utilize a short bevel needle. […] This may be done by monitoring of evoked motor response at thresholds below 0.5.

• #39

  https://link.springer.com/article/10.1007/s11916-024-01268-w

  Postoperative nerve injury after nerve block is complex and multifactorial. […] This review article conducts a literature search and summarizes current evidence and best practices in prevention of nerve injury. […] Studies show avoidance of intrafascicular injection, limiting concentrations/volumes of local anesthetic, and appropriate patient selection are the most significant controllable factors in limiting the negative consequences of nerve block. […] Prevention of nerve injury by surgical teams, care with positioning, and avoidance of intrafascicular injection with nerve block are the most evidence-based practices. […] True anesthetic consideration would be to avoid intrafascicular injection to reduce neurotoxic axonal injury secondary to local anesthetic exposure. […] While engaging in nerve block, the few things within the operator purview are to minimize possibility of intrafascicular injection or needle placement and to utilize a short bevel needle. […] This may be done by monitoring of evoked motor response at thresholds below 0.5.

• #40

  https://link.springer.com/article/10.1007/s11916-024-01268-w

  Postoperative nerve injury after nerve block is complex and multifactorial. […] This review article conducts a literature search and summarizes current evidence and best practices in prevention of nerve injury. […] Studies show avoidance of intrafascicular injection, limiting concentrations/volumes of local anesthetic, and appropriate patient selection are the most significant controllable factors in limiting the negative consequences of nerve block. […] Prevention of nerve injury by surgical teams, care with positioning, and avoidance of intrafascicular injection with nerve block are the most evidence-based practices. […] True anesthetic consideration would be to avoid intrafascicular injection to reduce neurotoxic axonal injury secondary to local anesthetic exposure. […] While engaging in nerve block, the few things within the operator purview are to minimize possibility of intrafascicular injection or needle placement and to utilize a short bevel needle. […] This may be done by monitoring of evoked motor response at thresholds below 0.5.

• #41

  https://link.springer.com/article/10.1007/s11916-024-01268-w

  Postoperative nerve injury after nerve block is complex and multifactorial. […] This review article conducts a literature search and summarizes current evidence and best practices in prevention of nerve injury. […] Studies show avoidance of intrafascicular injection, limiting concentrations/volumes of local anesthetic, and appropriate patient selection are the most significant controllable factors in limiting the negative consequences of nerve block. […] Prevention of nerve injury by surgical teams, care with positioning, and avoidance of intrafascicular injection with nerve block are the most evidence-based practices. […] True anesthetic consideration would be to avoid intrafascicular injection to reduce neurotoxic axonal injury secondary to local anesthetic exposure. […] While engaging in nerve block, the few things within the operator purview are to minimize possibility of intrafascicular injection or needle placement and to utilize a short bevel needle. […] This may be done by monitoring of evoked motor response at thresholds below 0.5.

• #42

  https://link.springer.com/article/10.1007/s11916-024-01268-w

  Postoperative nerve injury after nerve block is complex and multifactorial. […] This review article conducts a literature search and summarizes current evidence and best practices in prevention of nerve injury. […] Studies show avoidance of intrafascicular injection, limiting concentrations/volumes of local anesthetic, and appropriate patient selection are the most significant controllable factors in limiting the negative consequences of nerve block. […] Prevention of nerve injury by surgical teams, care with positioning, and avoidance of intrafascicular injection with nerve block are the most evidence-based practices. […] True anesthetic consideration would be to avoid intrafascicular injection to reduce neurotoxic axonal injury secondary to local anesthetic exposure. […] While engaging in nerve block, the few things within the operator purview are to minimize possibility of intrafascicular injection or needle placement and to utilize a short bevel needle. […] This may be done by monitoring of evoked motor response at thresholds below 0.5.

• #43 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #44 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #45 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #46 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #47 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #48 Postpartum Peripheral Nerve Injuries – What is Anesthesia’s Role? – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/postpartum-peripheral-nerve-injuries-what-is-anesthesias-role/

  Postpartum peripheral nerve injuries occur in approximately 0.3–2% of all deliveries. […] It is important that anesthesia professionals create systems to identify women who have experienced postpartum lower extremity nerve injuries and connect patients with resources. […] Anesthesia professionals should work with the obstetricians and nurses at their institution to ensure that all patients are evaluated after delivery and asked about symptoms consistent with postpartum lower extremity nerve injuries. […] If a nerve injury is detected, the nerve(s) affected should be identified, and the injury described in the medical record (motor, sensory, or mixed). […] The patient should also be evaluated by physical therapy or physiatry to ensure that the patient is safe to ambulate with her infant prior to discharge from the hospital.

• #49 Postpartum Peripheral Nerve Injuries – What is Anesthesia’s Role? – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/postpartum-peripheral-nerve-injuries-what-is-anesthesias-role/

  Postpartum peripheral nerve injuries occur in approximately 0.3–2% of all deliveries. […] It is important that anesthesia professionals create systems to identify women who have experienced postpartum lower extremity nerve injuries and connect patients with resources. […] Anesthesia professionals should work with the obstetricians and nurses at their institution to ensure that all patients are evaluated after delivery and asked about symptoms consistent with postpartum lower extremity nerve injuries. […] If a nerve injury is detected, the nerve(s) affected should be identified, and the injury described in the medical record (motor, sensory, or mixed). […] The patient should also be evaluated by physical therapy or physiatry to ensure that the patient is safe to ambulate with her infant prior to discharge from the hospital.

• #50 Postpartum Peripheral Nerve Injuries – What is Anesthesia’s Role? – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/postpartum-peripheral-nerve-injuries-what-is-anesthesias-role/

  Postpartum peripheral nerve injuries occur in approximately 0.3–2% of all deliveries. […] It is important that anesthesia professionals create systems to identify women who have experienced postpartum lower extremity nerve injuries and connect patients with resources. […] Anesthesia professionals should work with the obstetricians and nurses at their institution to ensure that all patients are evaluated after delivery and asked about symptoms consistent with postpartum lower extremity nerve injuries. […] If a nerve injury is detected, the nerve(s) affected should be identified, and the injury described in the medical record (motor, sensory, or mixed). […] The patient should also be evaluated by physical therapy or physiatry to ensure that the patient is safe to ambulate with her infant prior to discharge from the hospital.

• #51 Postpartum Peripheral Nerve Injuries – What is Anesthesia’s Role? – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/postpartum-peripheral-nerve-injuries-what-is-anesthesias-role/

  Postpartum peripheral nerve injuries occur in approximately 0.3–2% of all deliveries. […] It is important that anesthesia professionals create systems to identify women who have experienced postpartum lower extremity nerve injuries and connect patients with resources. […] Anesthesia professionals should work with the obstetricians and nurses at their institution to ensure that all patients are evaluated after delivery and asked about symptoms consistent with postpartum lower extremity nerve injuries. […] If a nerve injury is detected, the nerve(s) affected should be identified, and the injury described in the medical record (motor, sensory, or mixed). […] The patient should also be evaluated by physical therapy or physiatry to ensure that the patient is safe to ambulate with her infant prior to discharge from the hospital.

• #52 Polyethylene Glycol Treatment for Peripheral Nerve Repair in Preclinical Models

  https://www.jneurology.com/articles/polyethylene-glycol-treatment-for-peripheral-nerve-repair-in-preclinical-models.html

  Peripheral nerve injuries commonly result from trauma and can lead to devastating loss of sensory and motor function. […] Several animal studies have illustrated PEGs potential to help prevent axon loss after peripheral nerve injury. […] The majority of studies reported positive outcomes when using PEG; this indicates that PEG treatment has the potential to enhance peripheral nerve regeneration after injury. […] Many clinicians believe the predominant factor for the poor outcomes following these injuries is a failure to reestablish membrane continuity in the nerve. […] This theory has led clinicians to seek out a variety of therapeutic measures that promote axonal fusion, including polyethylene glycol (PEG). […] When combined with a calcium-free solution PEG can promote the fusion of axon plasma membranes and prevent the axon loss that occurs in Wallerian degeneration following peripheral nerve injury.

• #53 Peripheral Neuropathy | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html

  Can peripheral neuropathy (PN) be prevented? […] There are some therapies that have been used to prevent or limit the effects of peripheral neuropathy caused by chemotherapy, but more research is needed to prove they are effective. […] During chemo infusions, some experts recommend: […] Cold therapy (Cryotherapy): This involves cooling down your hands and feet during your chemo infusions. This is often done by freezing ice packs that fit into special socks and mittens or gloves. […] Compression therapy: This involves wearing tight gloves to compress (squeeze) your fingertips during your chemo infusions. This is often done by wearing two pairs of tight-fitting disposable nitrile or latex gloves. […] These therapies may help by reducing circulation in the hands and feet while chemo is being given, which may lower the amount of chemo drugs reaching these areas. More research is needed to prove these methods are effective and to determine the best ways to apply cold or compression.

• #54 Polyethylene Glycol Treatment for Peripheral Nerve Repair in Preclinical Models

  https://www.jneurology.com/articles/polyethylene-glycol-treatment-for-peripheral-nerve-repair-in-preclinical-models.html

  Peripheral nerve injuries commonly result from trauma and can lead to devastating loss of sensory and motor function. […] Several animal studies have illustrated PEGs potential to help prevent axon loss after peripheral nerve injury. […] The majority of studies reported positive outcomes when using PEG; this indicates that PEG treatment has the potential to enhance peripheral nerve regeneration after injury. […] Many clinicians believe the predominant factor for the poor outcomes following these injuries is a failure to reestablish membrane continuity in the nerve. […] This theory has led clinicians to seek out a variety of therapeutic measures that promote axonal fusion, including polyethylene glycol (PEG). […] When combined with a calcium-free solution PEG can promote the fusion of axon plasma membranes and prevent the axon loss that occurs in Wallerian degeneration following peripheral nerve injury.

• #55 Polyethylene Glycol Treatment for Peripheral Nerve Repair in Preclinical Models

  https://www.jneurology.com/articles/polyethylene-glycol-treatment-for-peripheral-nerve-repair-in-preclinical-models.html

  Peripheral nerve injuries commonly result from trauma and can lead to devastating loss of sensory and motor function. […] Several animal studies have illustrated PEGs potential to help prevent axon loss after peripheral nerve injury. […] The majority of studies reported positive outcomes when using PEG; this indicates that PEG treatment has the potential to enhance peripheral nerve regeneration after injury. […] Many clinicians believe the predominant factor for the poor outcomes following these injuries is a failure to reestablish membrane continuity in the nerve. […] This theory has led clinicians to seek out a variety of therapeutic measures that promote axonal fusion, including polyethylene glycol (PEG). […] When combined with a calcium-free solution PEG can promote the fusion of axon plasma membranes and prevent the axon loss that occurs in Wallerian degeneration following peripheral nerve injury.

• #56 Polyethylene Glycol Treatment for Peripheral Nerve Repair in Preclinical Models

  https://www.jneurology.com/articles/polyethylene-glycol-treatment-for-peripheral-nerve-repair-in-preclinical-models.html

  The addition of calcium-free solutions such as methylene blue cause the axon ends to remain patent, and the added PEG, hydrophilic in nature, helps remove water from the damaged lipid bilayer of the plasmalemma. […] Given the great success in animal models and low risk profile of the PEG substances, investigators have advocated for an early transition of PEG fusogen to human investigations. […] Based on this systematic review and despite this limited case series, the use of PEG solution for PNI treatment is very promising with significant implications in humans.

• #57 Peripheral Neuropathy | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html

  Can peripheral neuropathy (PN) be prevented? […] There are some therapies that have been used to prevent or limit the effects of peripheral neuropathy caused by chemotherapy, but more research is needed to prove they are effective. […] During chemo infusions, some experts recommend: […] Cold therapy (Cryotherapy): This involves cooling down your hands and feet during your chemo infusions. This is often done by freezing ice packs that fit into special socks and mittens or gloves. […] Compression therapy: This involves wearing tight gloves to compress (squeeze) your fingertips during your chemo infusions. This is often done by wearing two pairs of tight-fitting disposable nitrile or latex gloves. […] These therapies may help by reducing circulation in the hands and feet while chemo is being given, which may lower the amount of chemo drugs reaching these areas. More research is needed to prove these methods are effective and to determine the best ways to apply cold or compression.

• #58 Peripheral Neuropathy | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html

  Can peripheral neuropathy (PN) be prevented? […] There are some therapies that have been used to prevent or limit the effects of peripheral neuropathy caused by chemotherapy, but more research is needed to prove they are effective. […] During chemo infusions, some experts recommend: […] Cold therapy (Cryotherapy): This involves cooling down your hands and feet during your chemo infusions. This is often done by freezing ice packs that fit into special socks and mittens or gloves. […] Compression therapy: This involves wearing tight gloves to compress (squeeze) your fingertips during your chemo infusions. This is often done by wearing two pairs of tight-fitting disposable nitrile or latex gloves. […] These therapies may help by reducing circulation in the hands and feet while chemo is being given, which may lower the amount of chemo drugs reaching these areas. More research is needed to prove these methods are effective and to determine the best ways to apply cold or compression.

• #59 Peripheral Neuropathy | American Cancer Society

  https://www.cancer.org/cancer/managing-cancer/side-effects/pain/peripheral-neuropathy.html

  Exercising at least twice a week, including strength, balance, and general movement exercises, might also lower your risk for neuropathy. Exercise may improve circulation to support nerve health and help keep you stronger and healthier during treatment. But again, more research is needed to understand how exercise might help prevent CIPN. […] These methods can be used alone or together. Ask your cancer care team about options that might be best for you.

• #60 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. […] Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. […] This guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. […] Nerve damage requiring surgical treatment should undergo appropriate microsurgy as soon as possible in order to achieve early and optimal reinnervation.

• #61 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. Furthermore, since nerve injuries often go unrecognized or are recognized too late, this guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. This is supported not only by a handful of studies with moderate quality of evidence but also, and most importantly, by clinical experience. Nerve damage requiring surgical treatment should undergo appropriate microsurgery as soon as possible in order to achieve early and optimal reinnervation.

• #62 Preventing perioperative peripheral nerve injuries – PubMed

  https://pubmed.ncbi.nlm.nih.gov/23265653/

  Peripheral nerve injuries are largely preventable injuries that can result from incorrect patient positioning during surgery. […] Careful attention to body alignment and proper padding of bony prominences when positioning patients for surgery is necessary to prevent peripheral nerve injury. […] The use of a preoperative assessment tool to identify at-risk patients, collaboration between physical therapy and OR staff members regarding patient positioning, and neurophysiological monitoring can help prevent peripheral nerve injuries.

• #63 Postpartum Peripheral Nerve Injuries – What is Anesthesia’s Role? – Anesthesia Patient Safety Foundation

  https://www.apsf.org/article/postpartum-peripheral-nerve-injuries-what-is-anesthesias-role/

  Further research is needed to help understand which factors place patients at increased risk for these injuries. […] Anesthesia professionals can directly impact safety by educating other perinatal providers and ensuring that all patients, regardless of whether or not they had a neuraxial procedure, are assessed by a provider for new-onset postpartum nerve injuries.

• #64 Brachial plexus and peripheral nerve injuries | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/brachial-plexus-and-peripheral-nerve-injuries

  Brachial plexus and peripheral nerve injuries refer to injuries to the group of nerves that supply the arms and hands. […] Nevertheless, it is still important for them to be followed by a medical team early after the injury to monitor their recovery and ensure that additional treatment is not needed. […] For all patients, we encourage regular sessions with occupational therapy, whether it is at Childrens Hospital of Philadelphia or locally if patients live outside the Philadelphia region. […] Goals for therapy focus on: Promoting nerve recovery, Preventing joint contractures, Maintaining range of motion in the upper extremities and neck, Facilitating optimal use and typical movement patterns. […] Early surgical intervention for brachial plexus and other nerve damage is usually decided between three to six months after injury. […] Children with brachial plexus and peripheral nerve injuries are followed by our Brachial Plexus Program, which brings together a variety of pediatric subspecialists who monitor each patient closely for recovery and additional nerve damage that may require further treatment.

• #65 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  Open injuries require immediate treatment, while closed injuries with proven discontinuity should be reconstructed within 12 weeks. […] If regeneration does not occur, the further treatment concept should be determined within 6 months of the trauma, but as early as possible, and surgical nerve exploration should be considered. […] An interdisciplinary collaboration between all specialist areas is of paramount importance for the best possible restoration of function.

• #66 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616

  In the case of primary and secondary nerve sutures, tension-free coaptation of the nerve ends shall be ensured. […] If tension-free coaptation is not possible, nerve reconstruction must be performed. In addition to classical autologous transplants, a variety of autologous or alternative conduits are also available. […] The frequently problematic or incomplete healing of peripheral nerve injuries can only be reduced by a guideline-compliant combination of early diagnosis and correct treatment measures. An interdisciplinary collaboration between all specialist areas is of paramount importance for the best possible restoration of function.

• #67 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #68 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. […] The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. […] Early recognition of a peripheral nerve injury is essential. Prompt and appropriate intervention may prevent further deterioration, reduce the risk of neuropathic pain sensitization and improve the chance of a meaningful recovery for a mixed or motor nerve.

• #69 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. […] The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. […] Early recognition of a peripheral nerve injury is essential. Prompt and appropriate intervention may prevent further deterioration, reduce the risk of neuropathic pain sensitization and improve the chance of a meaningful recovery for a mixed or motor nerve.

• #70 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. […] The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. […] Early recognition of a peripheral nerve injury is essential. Prompt and appropriate intervention may prevent further deterioration, reduce the risk of neuropathic pain sensitization and improve the chance of a meaningful recovery for a mixed or motor nerve.

• #71 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. […] The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. […] Early recognition of a peripheral nerve injury is essential. Prompt and appropriate intervention may prevent further deterioration, reduce the risk of neuropathic pain sensitization and improve the chance of a meaningful recovery for a mixed or motor nerve.

• #72 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. […] The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. […] Early recognition of a peripheral nerve injury is essential. Prompt and appropriate intervention may prevent further deterioration, reduce the risk of neuropathic pain sensitization and improve the chance of a meaningful recovery for a mixed or motor nerve.

• #73 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Trauma surgery poses a specific risk of iatrogenic nerve injury. […] The operating surgeon must examine the patient and determine the site and grade of nerve injury prior to surgery. […] Failure to adhere to these simple guidelines may result in mislabelling traumatic nerve injuries as iatrogenic, failure to explore and decompress a critically injured nerve and missing an opportunity for management of the fracture and the nerve in the same procedure. […] The British Orthopaedic Association has provided comprehensive guidance for the management of peripheral nerve injuries, first in 2011, and then summarized in 2012 in the form of Standards for Trauma BOAST 5. […] Risk reduction can be affected through knowledge and skills acquisition as a part of orthopaedic training. Understanding the types of injuries that are associated with specific interventions, early recognition of a suspected nerve injury and the process of investigation and management are critical.

• #74 Peripheral nerve injuries – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/symptoms-causes/syc-20355631

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] If you experience weakness, tingling, numbness or a total loss of feeling, see your healthcare professional to find out the cause. It’s important to treat peripheral nerve injuries early. […] People who experience physical trauma or play sports may be at higher risk of an injury that can stretch or crush peripheral nerves. People with certain medical conditions also may be at higher risk of peripheral nerve injuries. These conditions, especially diabetes, may put nerves at greater risk of compression.

• #75 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. […] Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. […] This guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. […] Nerve damage requiring surgical treatment should undergo appropriate microsurgy as soon as possible in order to achieve early and optimal reinnervation.

• #76 Peripheral nerve injuries – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/peripheral-nerve-injuries/symptoms-causes/syc-20355631

  It’s important to get medical care for a peripheral nerve injury as soon as possible. Early diagnosis and treatment may prevent complications and permanent damage. […] If you experience weakness, tingling, numbness or a total loss of feeling, see your healthcare professional to find out the cause. It’s important to treat peripheral nerve injuries early. […] People who experience physical trauma or play sports may be at higher risk of an injury that can stretch or crush peripheral nerves. People with certain medical conditions also may be at higher risk of peripheral nerve injuries. These conditions, especially diabetes, may put nerves at greater risk of compression.

• #77 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. […] Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. […] This guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. […] Nerve damage requiring surgical treatment should undergo appropriate microsurgy as soon as possible in order to achieve early and optimal reinnervation.

• #78 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. Furthermore, since nerve injuries often go unrecognized or are recognized too late, this guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. This is supported not only by a handful of studies with moderate quality of evidence but also, and most importantly, by clinical experience. Nerve damage requiring surgical treatment should undergo appropriate microsurgery as soon as possible in order to achieve early and optimal reinnervation.

• #79 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  Open injuries require immediate treatment, while closed injuries with proven discontinuity should be reconstructed within 12 weeks. […] If regeneration does not occur, the further treatment concept should be determined within 6 months of the trauma, but as early as possible, and surgical nerve exploration should be considered. […] An interdisciplinary collaboration between all specialist areas is of paramount importance for the best possible restoration of function.

• #80 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  Open injuries require immediate treatment, while closed injuries with proven discontinuity should be reconstructed within 12 weeks. […] If regeneration does not occur, the further treatment concept should be determined within 6 months of the trauma, but as early as possible, and surgical nerve exploration should be considered. […] An interdisciplinary collaboration between all specialist areas is of paramount importance for the best possible restoration of function.

• #81 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  An understanding of specific procedural profiles, potential injury mechanisms, common anatomical sites and risk-reduction strategies help to avoid injury. […] A failure to adequately examine a patient pre-operatively, particularly in the setting of trauma surgery, may lead to false accusations of a peri-operative injury. […] In complex cases requiring reconstruction or in cases where there is the potential for breakdown of the clinician-patient relationship, onward referral to a specialist peripheral nerve injury unit (PNIU) is recommended. […] The primary clinician commonly diagnoses a neurapraxia, anticipating a full and timely recovery. […] The exploration should be planned after communication with the primary surgeon because in some situations there is a requirement for revision of the fixation or arthroplasty in order to improve the potential for recovery in the affected nerve.

• #82 Iatrogenic peripheral nerve injury: a guide to management for the orthopaedic limb surgeon in: EFORT Open Reviews Volume 6 Issue 8 (2021)

  https://eor.bioscientifica.com/view/journals/eor/6/8/2058-5241.6.200123.xml

  Nerves may be inadvertently injured during trauma surgery due to distorted anatomy, traction applied to a limb, soft tissue retraction, by power tools, instrumentation and from compartment syndrome. Elective orthopaedic surgery has additional risks of joint dislocation for arthroplasty surgery, limb lengthening, thermal injury from cement and direct injury from peripheral nerve blocks. […] The focus of this review is to raise awareness of iatrogenic peripheral nerve injuries in orthopaedic limb surgery, the importance of regular clinical examination, the role of investigations, timing and nature of interventions and also to provide a guide to when onward referral to a specialist peripheral nerve injury unit is recommended. […] Early recognition of a peripheral nerve injury is essential. Prompt and appropriate intervention may prevent further deterioration, reduce the risk of neuropathic pain sensitization and improve the chance of a meaningful recovery for a mixed or motor nerve.

• #83 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. […] Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. […] This guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. […] Nerve damage requiring surgical treatment should undergo appropriate microsurgy as soon as possible in order to achieve early and optimal reinnervation.

• #84 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. Furthermore, since nerve injuries often go unrecognized or are recognized too late, this guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. This is supported not only by a handful of studies with moderate quality of evidence but also, and most importantly, by clinical experience. Nerve damage requiring surgical treatment should undergo appropriate microsurgery as soon as possible in order to achieve early and optimal reinnervation.

• #85

  https://www.scielo.br/j/anp/a/pxWRK8YRSxN9pX4ZG8LwTRw/

  Therefore, spontaneous recovery is possible and surgery is indicated only after 3 months if no recovery is identified. This period is arbitrated based on axonal growth rate (13 mm/day) and improvement identified on clinical or electromyographic evaluation. Conversely, the occurrence of an open injury related to a nerve course has been more frequently related to neurotmetic injuries and must be treated with early surgery. […] In summary, surgical timing in a traumatic peripheral nerve injury is defined by the rule of three: immediate surgery within 3 days for clean and sharp injuries; early surgery within 3 weeks for blunt/contusion injuries; and delayed surgery, performed 3 months after injury, for closed injuries. […] A prompt and adequate handle of these lesions can result in the recovery, at least partially, of the lost function. Therefore it is fundamental to understand the mechanisms and peculiarities of these lesions in order to define an acceptable time for surgical intervention. Timely nerve reconstruction performed with suitable microsurgical technique improves the functional recovery of this disabling condition.

• #86

  https://www.scielo.br/j/anp/a/pxWRK8YRSxN9pX4ZG8LwTRw/

  Therefore, spontaneous recovery is possible and surgery is indicated only after 3 months if no recovery is identified. This period is arbitrated based on axonal growth rate (13 mm/day) and improvement identified on clinical or electromyographic evaluation. Conversely, the occurrence of an open injury related to a nerve course has been more frequently related to neurotmetic injuries and must be treated with early surgery. […] In summary, surgical timing in a traumatic peripheral nerve injury is defined by the rule of three: immediate surgery within 3 days for clean and sharp injuries; early surgery within 3 weeks for blunt/contusion injuries; and delayed surgery, performed 3 months after injury, for closed injuries. […] A prompt and adequate handle of these lesions can result in the recovery, at least partially, of the lost function. Therefore it is fundamental to understand the mechanisms and peculiarities of these lesions in order to define an acceptable time for surgical intervention. Timely nerve reconstruction performed with suitable microsurgical technique improves the functional recovery of this disabling condition.

• #87

  https://www.scielo.br/j/anp/a/pxWRK8YRSxN9pX4ZG8LwTRw/

  Therefore, spontaneous recovery is possible and surgery is indicated only after 3 months if no recovery is identified. This period is arbitrated based on axonal growth rate (13 mm/day) and improvement identified on clinical or electromyographic evaluation. Conversely, the occurrence of an open injury related to a nerve course has been more frequently related to neurotmetic injuries and must be treated with early surgery. […] In summary, surgical timing in a traumatic peripheral nerve injury is defined by the rule of three: immediate surgery within 3 days for clean and sharp injuries; early surgery within 3 weeks for blunt/contusion injuries; and delayed surgery, performed 3 months after injury, for closed injuries. […] A prompt and adequate handle of these lesions can result in the recovery, at least partially, of the lost function. Therefore it is fundamental to understand the mechanisms and peculiarities of these lesions in order to define an acceptable time for surgical intervention. Timely nerve reconstruction performed with suitable microsurgical technique improves the functional recovery of this disabling condition.

• #88 Preventing perioperative peripheral nerve injuries – PubMed

  https://pubmed.ncbi.nlm.nih.gov/23265653/

  Peripheral nerve injuries are largely preventable injuries that can result from incorrect patient positioning during surgery. […] Careful attention to body alignment and proper padding of bony prominences when positioning patients for surgery is necessary to prevent peripheral nerve injury. […] The use of a preoperative assessment tool to identify at-risk patients, collaboration between physical therapy and OR staff members regarding patient positioning, and neurophysiological monitoring can help prevent peripheral nerve injuries.

• #89 Peripheral nerve injuries in athletes. Treatment and prevention – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8378668/

  Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete’s safe return to sports. […] Proper equipment, technique and conditioning are the keys to prevention. […] Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment.

• #90 Peripheral Nerve Injuries and Positioning for General Anaesthesia : Virtual Library

  https://resources.wfsahq.org/atotw/peripheral-nerve-injuries-and-positioning-for-general-anaesthesia/

  Peripheral nerve injuries are often related to positioning of the patient and to the surgical procedure. […] Attention to minimising risk factors can decrease the incidence of nerve insult. […] Final positioning should be carefully assessed before draping commences. […] Good documentation of anaesthetic care includes specific information on positioning, including stating when padding has been used. […] The aim of surgical positioning is to allow good surgical access while minimising risk of harm to the patient. […] Safe patient positioning includes ensuring that; The patient is secure on the operating table, All limbs are placed in natural positions without stretch to nerves/muscles/tendons/vessels, All pressure areas are padded and eyes are protected. […] Peripheral nerve injuries are often related to positioning of the patient and to the surgical procedure.

• #91

  https://journals.lww.com/neur/fulltext/2019/67001/iatrogenic_peripheral_nerve_injuries.29.aspx

  Iatrogenic peripheral nerve injury is a considerable social and economic concern and the majority of cases are preventable. […] Their prevention should be emphasized. […] Peripheral nerve injuries are commonly attributed to improper patient positioning and lengthy surgeries. […] Appropriate padding of bony prominences when positioning the patients for surgery is indispensable in preventing iatrogenic peripheral nerve injuries. […] Cautious positioning of every patient on the operating table will reduce, but not eliminate, injuries to the peripheral nerves. […] The anaesthetist should be aware of the potential for nerve injury, and interventions which can minimise the risk should be initiated. […] The use of restraints in medical practice is seen as a necessary evil and alternative methods like chemical restraints and the usage of behavioural therapy should be encouraged.

• #92 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616/The-treatment-of-peripheral-nerve-injuries

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. […] Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. […] This guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. […] Nerve damage requiring surgical treatment should undergo appropriate microsurgy as soon as possible in order to achieve early and optimal reinnervation.

• #93 The Treatment of Peripheral Nerve Injuries (09.08.2024)

  https://di.aerzteblatt.de/int/archive/article/240616

  The delayed or improper treatment of peripheral nerve lesions can lead to severe impairment. Timely diagnosis, the use of appropriate treatments in conformity with the guidelines, and interdisciplinary collaboration among specialists are all essential for optimizing the outcome. […] Therefore, the right timing for nerve reconstruction plays a particularly important role in motor nerve damage. Furthermore, since nerve injuries often go unrecognized or are recognized too late, this guideline is intended to promote the early recognition of nerve lesions and the timely initiation of proper treatment for optimal restoration of function. […] The time aspect takes highest priority in the treatment of peripheral nerve injuries. This is supported not only by a handful of studies with moderate quality of evidence but also, and most importantly, by clinical experience. Nerve damage requiring surgical treatment should undergo appropriate microsurgery as soon as possible in order to achieve early and optimal reinnervation.

• #94 Polyethylene Glycol Treatment for Peripheral Nerve Repair in Preclinical Models

  https://www.jneurology.com/articles/polyethylene-glycol-treatment-for-peripheral-nerve-repair-in-preclinical-models.html

  Peripheral nerve injuries commonly result from trauma and can lead to devastating loss of sensory and motor function. […] Several animal studies have illustrated PEGs potential to help prevent axon loss after peripheral nerve injury. […] The majority of studies reported positive outcomes when using PEG; this indicates that PEG treatment has the potential to enhance peripheral nerve regeneration after injury. […] Many clinicians believe the predominant factor for the poor outcomes following these injuries is a failure to reestablish membrane continuity in the nerve. […] This theory has led clinicians to seek out a variety of therapeutic measures that promote axonal fusion, including polyethylene glycol (PEG). […] When combined with a calcium-free solution PEG can promote the fusion of axon plasma membranes and prevent the axon loss that occurs in Wallerian degeneration following peripheral nerve injury.

• #95 Polyethylene Glycol Treatment for Peripheral Nerve Repair in Preclinical Models

  https://www.jneurology.com/articles/polyethylene-glycol-treatment-for-peripheral-nerve-repair-in-preclinical-models.html

  The addition of calcium-free solutions such as methylene blue cause the axon ends to remain patent, and the added PEG, hydrophilic in nature, helps remove water from the damaged lipid bilayer of the plasmalemma. […] Given the great success in animal models and low risk profile of the PEG substances, investigators have advocated for an early transition of PEG fusogen to human investigations. […] Based on this systematic review and despite this limited case series, the use of PEG solution for PNI treatment is very promising with significant implications in humans.

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