1.29 Postoperative Neuropathy

Question 1

DDx pain and tingling post op tingling (L arm)

Answer 1

Cardiac
Angina / Ischaemia

CNS/PNS:

1 Migraine

2 CVA TIA

3 Seizure / aura

4 Periop BP traction injury

5 Peripheral nerve trunk compression from positioning

6 Undx carpal tunnel

7 Compartment Sy

Resp:
Hyperventilation

Other:
Thromboembolic
Hypoglycaemia / hypocalcaemia
LAST

Question 2

Initial Mx Post op neuropathy

Answer 2

1. ID underlying cause
2. Baseline obs r/v and repeated
3. 12 lead ECG exclude cardiac cause
4. Systemic exam
   exclude potential ddx and assoc sx or sy

Check NV status L arm

5. Metabolic / resp
   U+E & ABG
6. Neuro cause
   medical on call TIA / CVA mx scanning
7. DW patient
   explain aetiology + reassure
8. O2 analgesia and IV Fluids PRN
9. Measure compartment pressure
10. Remain recovery if Dx unclear

Question 3

Mx of compression Neuropathy

Answer 3

1. If expanding haematoma / vascular cause
   - urgent imaging + surgical r/f
2. Evacuation of haematoma w.in 24h of onset symptoms
   a/w better recovery
3. Surgical site involved - urgent surgical r/v
4. Exclude compartment syndrome
   - pain on passive movement
   surgery priority
   Decompressive fasciotomy
5. Post op neuropathy
   0.4% GA 0.1% RA
   up to 14 days post op
6. Position usually cited
   - Cause only found <10% cases

Question 4

Mx compression neuropathy

Answer 4

1. Following acute and reversible causes explanation of likely progression of injury
   subsequent management
   first step to reassure

2 Development of acute pain not uncommon
best managed referral to acute pain team

3 Detailed notes of exam findings discussion patient and other specialties

4. Inform on call anaes consultant
   medical defence org
5. R/F to neurologist
   establish diagnosis + follow up
   discussion w/ GP
6. Suggest appointment w/ patient in future
   r/v process and further q’s