Postsurgical Inflammatory Neuropathy

Abstract

Perioperative nerve deficits not readily explained by direct surgical or anesthesia-related causes should prompt early neurologic consultation to seek alternative etiologies such as postsurgical inflammatory neuropathy. Although this condition is poorly understood, it is believed to be an idiopathic immune-mediated response to a physiologic stress (eg, surgery, regional block) and is treated with prolonged, high-dose corticosteroids. Because suppression of the immune system with high-dose steroids may result in improved neurologic outcome, it is essential that surgeons and anesthesiologists are aware of this condition so that treatment is not delayed.

Pathophysiology and Etiology of Nerve Injury Following Peripheral Nerve Blockade

“…44,45 Nonspecific inflammatory responses targeting peripheral nerves can occur either remote or near the site of surgery, where it becomes difficult to distinguish from other causes of PNI. Inflammatory mechanisms have recently been proposed as the cause for persistent phrenic nerve injury following interscalene block for shoulder surgery.…”

Selective spinal anesthesia for outpatient transurethral prostatectomy (TURP): randomized controlled comparison of chloroprocaine with lidocaine

“…Neither a cauda equina syndrome nor TNS have been reported recently in any publications with the resurgence of CP in a preservative‐free formulation, and apart from this one case, we have not seen it in our practice. Recently, attention has been drawn to the development of postsurgical inflammatory neuropathy after combined general–bupivacaine epidural anesthesia . Such a syndrome should be considered in the differential diagnosis of an unexplained neuropathy that occurs after spinal or general anesthesia, and the diagnosis is confirmed by an abnormal nerve biopsy.…”

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

“…163,164 Distinguishing features of these neuropathies include their delayed appearance (within 30 days of surgery, although some may be apparent immediately), which is usually followed by a period of normal recovery. Clinical presentation also includes signs and symptoms outside of the expected location of anesthetic blockade or surgery and a period of intense pain out of proportion to what would be expected from the surgery, which then resolves, only to be followed by weakness.…”