Neuropraxia

Question 1

Neuropraxia - incidence and symptoms

Answer 1

Variable incidence - 0.03-1.4%
Symptoms may be:
- Neuropathic pain
- Sensory loss
- Motor weakness/ paralysis

Question 2

Nerves commonly injured during anaesthesia

Answer 2

Ulnar 28%
Brachial plexus 20%
Lumbosacral root 16%
Spinal cord 13%
Radial
Common Peroneal

Question 3

How to protect against ulnar neuropraxia

Answer 3

Padding at elbow
Supinated forearm
Avoid elbow extension and extreme flexion

Question 4

How to protect against brachial plexus neuropraxia

Answer 4

Avoid neck rotation and angulation to either side

Avoid shoulder abduction >90%

Question 5

Management and prevention of neuropraxia

Answer 5

Pre-op
- Examine and document
Intra-op
- Meticulous Positioning
- Avoid hypotension
- Avoid regional techniques
- Minimise tourniquet time
Post-op
- Assess/  document
- Neurology referral
- EMG & nerve conduction studies

Question 6

Risk factors for neuropraxis (in general)

Answer 6

Classify! Patient/ surgical/ anaesthetic factors

Patient:
Male
Elderly/ Frail
Vascular disease
Neuropathy pre-existing
Mass near course of nerve
Hypothermia

Surgical:
Surgical injury near course of nerve
Plaster Casts
Forceps delivery

Anaesthetic:
Improper positioning or padding (stretch/ pressure)
Hypotension
Regional technique with complications/ without safe technique