Abstract
Peripheral nerve injury following regional or general anesthesia is a relatively uncommon entity but, potentially, a serious complication of anesthesia. Most nerve injuries are related to either regional anesthesia or position-related complications, and they are rarely seen in association with the use of automated blood pressure monitoring. We describe a patient who developed neurological dysfunction of all the three major nerves, median, ulnar, and radial, after general anesthesia. The distribution of sensory motor deficit along with the nerve conduction study demonstrated the location of the anatomical nerve lesions coinciding with the automatic noninvasive blood pressure (NIBP) cuff. No other cause of nerve injury was identified except for the use of the NIBP cuff. In the absence of another identifiable cause, we strongly suspected the NIBP cuff compression as a possible cause for the nerve injuries. In this article, we will discuss the possible risk factors, mechanisms, diagnosis, and prevention of perioperative nerve injury.
Highlights
Perioperative peripheral nerve injuries (PPNIs) are a serious perioperative complication that can be encountered both in general and regional anesthesia
We describe a rare case of acute perioperative nerve injury involving all three main nerves of the upper limb, radial, ulnar, and median nerves of the same arm
Prolonged use of the automated blood pressure cuff has been implicated in few case reports involving a single or two major nerves of the upper limb [4,5,6,7]. e incidence of automatic blood pressure cuff-related nerve injury is unknown, as it has been described only in case reports
Summary
Perioperative peripheral nerve injuries (PPNIs) are a serious perioperative complication that can be encountered both in general and regional anesthesia. [2, 3] Of the upper extremity, injuries to the ulnar nerve 28% and brachial plexus 20% are the more common perioperative nerve injuries, while injury to the radial (3%) and median nerve (4%) is less frequent. We describe a rare case of acute perioperative nerve injury involving all three main nerves of the upper limb, radial, ulnar, and median nerves of the same arm. Prolonged use of the automated blood pressure cuff has been implicated in few case reports involving a single or two major nerves of the upper limb [4,5,6,7]. E incidence of automatic blood pressure cuff-related nerve injury is unknown, as it has been described only in case reports. All of the case reports showed single nerve injury, but in our case, all the major nerves of the left upper limb were affected
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