Perioperative nerve injury: A silent scream?

The data from Welch et al. denote the (minimal) frequency, scope, and demographics of perioperative neuropathies that impact clinicians in daily practice.1 The etiology of perioperative peripheral nerve injuries remains complex, multifactorial, and incompletely understood. Despite avoidance of traction, stretch, and excessive or prolonged pressure during surgery, perioperative peripheral nerve injuries can and do occur. Prospective studies suggest that many nerve injuries initially become symptomatic more than 2 days after surgery and anesthesia. Thus, it appears evident that perioperative neuropathies occur despite appropriate positioning and padding of limbs during surgery; that awake patients vary in their ability to detect peripheral nerves at risk, and individuals may or may not reposition afflicted limbs on their own; and that some adverse events classified as perioperative neuropathies have their origins and onset beyond the operating room or postoperative care unit.