Maggie Jordan

Background:  Postoperative peripheral neuropathy (PPN) is an outcome of significant concern for patients who undergo surgical procedures as well as their providers, often leading to prolonged patient morbidity and diminished quality of life. However, exact diagnosis criteria and mechanisms of injury for PPN remain unclear. Incidence rates vary widely depending on surgical type, with studies indicating up to 37% of patients undergoing breast surgery and 34% following lymph node dissection reporting symptoms consistent with neuropathic pain (Di Stefano et al., 2020; Rosenberger & Pogatzki-Zahn, 2022). Positional injuries remain an established cause, particularly following lengthy procedures and in patients with predisposing anatomical or physiological vulnerabilities (Lalkhen, 2015; Wolthers et al., 2022). This preliminary literature review synthesizes findings from recent and historical studies to better understand the incidence and risk factors, increase clinician awareness, and highlight strategies for mitigations of PPN.

Methods:  A literature review was conducted using databases including PubMed and Google Scholar. Search terms included “postoperative neuropathy,” “surgical neuropathy,” “nerve repair,” “stirrups neuropathy,” and “surgery positioning.” Relevant studies were selected based on their focus on PPN/post-surgical neuropathic pain, identification of risk factors such as patient characteristics or comorbidities, or discussion of treatments or mitigations like positioning during surgery or nerve repair therapy.

Preliminary Results:  Risk factors for PPN include patient-specific characteristics such as male sex, diabetes, and prior neuropathic conditions, as well as procedural variables including type of anesthesia, surgical positioning, and duration of surgery (Cheney et al., 1999; Chui et al., 2018). Ulnar and brachial plexus injuries are among the most common, particularly associated with general anesthesia and improper limb positioning (Cheney et al., 1999). Chronic postsurgical neuropathic pain (CPSNP), a subset of PPN, is frequently underdiagnosed and poorly managed despite its impact on long-term outcomes (Borsook et al., 2013; Prudhomme et al., 2020).

Emerging strategies for prevention and management include the development of nerve-sparing surgical techniques, improved perioperative monitoring, and biomaterial innovations such as engineered hydrogels that promote nerve regeneration (Liu et al., 2023). Additionally, better standardization of diagnostic criteria and nomenclature, as advocated by the International Association for the Study of Pain (IASP), is essential for improving clinical recognition and research consistency (Di Stefano et al., 2020).

Conclusions:  Further research and implementation of targeted preventive measures is required to better characterize the pathophysiology and incidence of PPN. Early identification of at-risk patients and adoption of intraoperative protocols or materials could substantially reduce the incidence rate and subsequent burden of PPN on surgical patient populations.

Works Cited

1. Borsook, D., Kussman, B. D., George, E., Becerra, L. R., & Burke, D. W. (2013). Surgically induced neuropathic pain: Understanding the perioperative process. Annals of Surgery, 257(3), 403–412. https://doi.org/10.1097/SLA.0b013e3182701a7b
2. Cheney, F. W., Domino, K. B., Caplan, R. A., & Posner, K. L. (1999). Nerve injury associated with anesthesia: A closed claims analysis. Anesthesiology, 90(4), 1062–1069. https://doi.org/10.1097/00000542-199904000-00020
3. Chui, J., Murkin, J. M., Posner, K. L., & Domino, K. B. (2018). Perioperative peripheral nerve injury after general anesthesia: A qualitative systematic review. Anesthesia & Analgesia, 127(1), 134–143. https://doi.org/10.1213/ANE.0000000000003420
4. Di Stefano, G., Di Lionardo, A., Di Pietro, G., & Truini, A. (2020). Neuropathic pain related to peripheral neuropathies according to the IASP grading system criteria. Brain Sciences, 11(1), 1. https://doi.org/10.3390/brainsci11010001
5. Lalkhen, A. G. (2015). Perioperative peripheral nerve injuries associated with surgical positioning. In R. S. Tubbs, E. Rizk, M. M. Shoja, M. Loukas, N. Barbaro, & R. J. Spinner (Eds.), Nerves and nerve injuries (pp. 587–602). Academic Press. https://doi.org/10.1016/B978-0-12-802653-3.00086-5
6. Liu, Y., Zhang, X., Xiao, C., et al. (2023). Engineered hydrogels for peripheral nerve repair. Materials Today Bio, 20, 100668. https://doi.org/10.1016/j.mtbio.2023.100668
7. Prudhomme, M., Legras, A., Delorme, C., Lansaman, T., Lanteri-Minet, M., Medioni, J., Navez, M., Perrot, S., Pickering, G., Serrie, A., & Viel, E. (2020). Management of neuropathic pain induced by surgery: Review of the literature by a group of experts specialized in pain management, anesthesia and surgery. Journal of Visceral Surgery, 157(1), 43–52. https://doi.org/10.1016/j.jviscsurg.2019.09.004
8. Rosenberger, D. C., & Pogatzki-Zahn, E. M. (2022). Chronic post-surgical pain—Update on incidence, risk factors and preventive treatment options. BJA Education, 22(5), 190–196. https://doi.org/10.1016/j.bjae.2021.11.008
9. Wolthers, S. A., Lassen, B. V., Rasmussen, L. T., et al. (2022). Position-related postoperative peripheral neuropathy after laparoscopic colorectal surgery: A comparative single-center prospective cohort study. Journal of Laparoendoscopic & Advanced Surgical Techniques, 32(4), 349–354. https://doi.org/10.1089/lap.2021.0021