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Positioning Injuries in Anesthesia: An Update

  • Armin Schubert
    Correspondence
    Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue/E31, Cleveland, OH 44195.
    Affiliations
    Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA

    Department of General Anesthesiology, Cleveland Clinic, 9500 Euclid Avenue/E31, Cleveland, OH 44195, USA
    Search for articles by this author
      Anesthesia professionals, operating room (OR) nurses, and surgeons worry about injury to skin and other organs when positioning the anesthetized patient. The true incidence of all perioperative position-related injury is subject to conjecture. An important type of position-related injury is peripheral nerve injury. The incidence varies with surgical procedure and positioning. For example, ulnar neuropathy has been found in as many as 26% of patients undergoing open-heart surgery [
      • Casscells C.D.
      • Lindsey R.W.
      • Ebersole J.
      • et al.
      Ulnar neuropathy after median sternotomy.
      ], whereas lower extremity neuropathy occurred in 1.5% of patients in the lithotomy position [
      • Warner M.A.
      • Warner D.O.
      • Harper C.M.
      • et al.
      Lower extremity neuropathies associated with lithotomy positions.
      ]. The incidence of ulnar neuropathy is estimated at 0.46% after noncardiac surgery [
      • Warner M.A.
      • Warner D.O.
      • Matsumoto J.Y.
      • et al.
      Ulnar neuropathy in surgical patients.
      ]. According to data from the American Society of Anesthesiologists (ASA) Closed Claims Database, peripheral nerve injuries represent the second largest class of adverse outcomes and account for 16% of all claims [
      • Cheney F.W.
      • Domino K.B.
      • Caplan R.A.
      • et al.
      Nerve injury associated with anesthesia: a closed claims analysis.
      ].
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