Prevention and Management of Ulnar Nerve Injuries Under General Anesthesia

Epidemiology and Risk Factors

Elderly patients are at higher risk of preventable peripheral nerve injuries during prolonged surgery, particularly affecting the ulnar nerve when in supine position 1

Every operating theatre should be equipped with quantitative neuromuscular monitoring devices to monitor nerve function throughout anesthesia 2
The ulnar nerve is the most useful site for neuromuscular monitoring, but readings may be unreliable if thumb movement is impeded 2
Padded armboards may decrease the risk of upper extremity neuropathies during positioning 3
Specific padding (e.g., foam or gel pads) at the elbow may decrease the risk of ulnar neuropathy 3
Perform a simple postoperative assessment of extremity nerve function for early recognition of peripheral neuropathies 4

In some circumstances, the use of padding may paradoxically increase the risk of peripheral neuropathies if applied incorrectly 3
Documentation of specific perioperative positioning actions is recommended for continuous improvement processes 4

Quantitative neuromuscular monitoring is essential and should be used throughout all phases of anesthesia 2
Probable sites of nerve injury should be comprehensively padded before surgery and assessed routinely every 30 minutes throughout the procedure 1
Monitoring should be applied after induction of general anesthesia but before neuromuscular blockade 2
Adequacy of recovery should be demonstrated and documented before patient awakening and extubation 2