Perioperative neuropathic and positional problems: literature review

Abstract

At present, an increasing number of specialists prefer the fast-track surgery concept. One of the significant perioperative complications that can affect the rate and quality of postoperative rehabilitation is the development of neuropathy, which can be the result of improper patient positioning on the operating table, and direct intraoperative damage to the nerve / trunk / plexus. Physical (mechanical compression, stretching, and partial / complete intersection of the nerve with a needle, scalpel, or electrode) and chemical (toxicity of local anesthetics and chemically active liquid effects) mechanisms for neuropathy formation can be described. To prevent the development of a neurological deficit, both the anesthesiologist and surgeon must take all the necessary measures to prevent neuropathies and begin appropriate treatment as soon as possible in the case of its occurrence. This article discusses the anatomy, physiology, and pathophysiology of the peripheral nerve, mechanisms of compression-ischemic neuropathy formation, and perioperative positional problems. Existing recommendations for the treatment of peripheral neuropathic were assessed and proposed for use not only with conservative therapy methods but also with interventional methods for the treatment of established perioperative neurological complications. A summary table of the possible clinical manifestations of postoperative neuropathic is presented.