Neurological Complications Related to Elective Orthopedic Surgery

Abstract

As the popularity of regional anesthesia continues to increase with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective hip and knee procedures.

Lower extremity regional anesthesia: essentials of our current understanding

“…For instance, total hip arthroplasty (THA) may result in injury to the common peroneal nerve (due its subcutaneous location) and to the femoral nerve (due to compression from an improperly placed retractor) 365. Furthermore, the superior gluteal and lateral femoral cutaneous nerves can be damaged with the lateral and anterior surgical approaches, respectively.…”

“…Total knee arthroplasty can result in impairment of the common peroneal nerve due to traction or compressive hematoma . Damage to the saphenous nerve may occur during arthroscopic meniscal repair and the infrapatellar branch can be harmed during ACL reconstruction 365. Because ankle arthroscopy is performed via anterior and posterior approaches, damage to cutaneous nerves may result from the placement of arthroscopic portals.…”

The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

“…Practitioners are encouraged to read the supporting articles that accompany this summary; they contain the details on which individual recommendations are based. [10][11][12][13][14][15][16] "Consistent with a recent editorial call to focus practice advisory and consensus conference updates on new material, 17 most supporting articles for individual topics considered by this advisory are built on 2 components. First, to provide perspective, those topics and associated recommendations for which no substantially new knowledge has emerged are reviewed briefly.…”

Plasma Ropivacaine Concentrations Following Local Infiltration Analgesia in Total Knee Arthroplasty

“…While intrathecal opioids and peripheral nerve blockade provide excellent analgesia, they may have significant adverse effects including nerve injury, nausea, and delayed mobilization. 2,3 The evidence for benefit of early mobilization, as well as the effectiveness and ease of administration of local anesthetic into and around the structures of the knee joint intraoperatively, has established local infiltration analgesia (LIA) as the routine analgesic technique for lower limb arthroplasty in some centers. 4,5 Local anesthetic administered into the soft tissues and joint has action on the terminal branches of peripheral sensory nerves, leading to analgesia without motor weakness.…”