1. Perioperative Peripheral Nerve Injuries
A Retrospective Study of 380,680 Cases during a 10-year Period at a Single Institution
Anesthesiology, V 111, No 3, Sep 2009
主講人 : 黃水元 醫師

2. Introduction
造成 peri-operative peripheral nerve injury 的原因 : patient comorbidities, positioning, surgical conditions, direct trauma
造成 nerve injury 的 病理機制 : stretch, compression, ischemia, metabolic/environmental abnormalities

3. Goals of the present study
To determine whether injury is associated with preexisting patient characteristics
To determine whether injury is associated with the type of anesthetic technique or surgical specialty
To determine the 10-yr frequency of peri-operative peripheral neuropathies

4. Materials and Methods
Definition of peri-operative peripheral nerve injury : new (within 48 h) sensory and/or motor deficit in any patient who had been sedated or anesthetized
Injuries as a result of the surgical procedure itself were excluded
Tertiary care university hospital from May 1997 to May 2007.

5. Results Total of 380,680 surgeries ; over a 10-yr period
480 cases of potential perioperative peripheral nerve injuries
Actually total of 112 perioperative peripheral nerve injuries
mean age : 46 yr (13 ~ 86 yr) Men : women = 54% : 46%

9. upper extremity > lower extremity

10. Sensory > motor

11. Discussion

12. Disease Associated with Nerve Injuries
DM, HTN, and tobacco use were associated with perioperative nerve injury
Diabetes : a known cause of chronic neuropathy and vascular disease.
Hypertension : -- a chronic disease process that affects blood flow, and may leave the nerve more susceptible to injury.

13. Ulnar Neuropathy
It was found to be a risk factor in the development of ulnar neuropathy and lower extremity neuropathy in the lithotomy position.
Especially patients with heavy sedation.
Conscious patients should retain more of their protective reflexes and be able to reposition themselves.

14. Possible Mechanism of Nerve Injuries
Mechanism of nerve injury to an anesthetized patient Ischemia , infarct
Patients with already compromised vasculature (ex. PAOD.) will be more susceptible to perioperative injury.
The use of pneumatic tourniquets has been associated with perioperative neuropathy in two previous studies.

15. Which Surgical Services
Distribution of the location of injuries : upper extremity > lower extremity
CVS surgery has a high incidence of nerve injury : median sternotomy leading to brachial plexus injuries hypothermia and hemodynamic changes during bypass -- internal jugular vein cannulation, internal mammary artery dissection
GS, Ortho, and NS were also found to be associated with injury

16. This is the largest number of consecutive patients ever reviewed for all types of perioperative peripheral nerve injuries.
The 10-yr frequency of perioperative peripheral nerve injuries : % ( 112/380,680 )
perioperative peripheral nerve injuries also noted in children : nerve injuries occurred in children

17. Conclusion
Higher risk of perioperative peripheral nerve injuries : -- metabolic syndrome : Hypertension, DM -- tobacco use -- vascular disease
Surgical services (CVS, GS, Ortho, NS), general anesthesia and epidural anesthesia were also uniquely noted to have associations.

18. Conclusion
Management : perioperative anesthetic care, proper positioning, adequate padding -- intermittent massage

19. Thank You for Attention !