Electrophysiologic testing for the diagnosis of peripheral nerve injuries.

Abstract

ANESTHESIOLOGISTS have an important role in preventing perioperative nerve injury, monitoring nerve function to minimize damage, and diagnosing peripheral nerve lesions at an early stage to optimize their management. The purpose of the current article is therefore to clarify the use and limitations of electrophysiologic testing in the diagnosis and management of anesthesiarelated nerve injuries. The occurrence of perioperative nerve injuries is well described. In the American Society of Anesthesiologists Closed Claims Database (a standardized collection of case summaries from the closed malpractice claims of a number of insurance companies), 16% of the 4,183 claims have been for anesthesia-related nerve injury. 1 Regional nerve block may lead to a focal nerve deficit. During surgery itself, direct injury or tourniquet compression to insure a bloodless field may be responsible. In rare instances, the compression is seemingly innocuous, as from a blood pressure cuff that inflates automatically at periodic intervals. 2 Malpositioning of patients during surgery may lead to com