Dataset Information

Peripheral Nerve Injury After Upper-Extremity Surgery Performed Under Regional Anesthesia: A Systematic Review.

ABSTRACT:

Purpose

Peripheral nerve injury (PNI) is a known adverse event following upper-limb surgery performed under brachial plexus regional anesthesia (RA). When PNI is noted after surgery, patients and providers often have questions about which factors might have contributed to this complication. This systematic review evaluates the literature on hand and shoulder surgeries performed under ultrasound-guided, plexus RA to identify factors potentially associated with PNI, including the surgery location and block type. We hypothesized that shoulder surgery might be associated with an increased risk of PNI compared to hand surgery.

Methods

A systematic review of the relevant literature was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Only prospective studies on the use of ultrasound-guided, preoperative, brachial plexus RA for hand or shoulder surgery on adult patients were included. Study groups were categorized according to surgery location and block type and compared across a number of factors via univariate and multivariate analyses.

Results

A total of 3,037 abstracts were screened; 192 full-text articles were independently reviewed by 2 of the authors; and 53 studies were included in the systematic review analysis. Following hand surgery, PNI was reported at an average rate of 1.35% ± 3.21% across 836 subjects in 40 study groups; after shoulder surgery, the average rate was 0.50% ± 1.57% across 3,383 subjects in 15 study groups. There was no statistically significant correlation between the incidence of PNI and surgery location (P =.70) or any of the most common approaches for brachial plexus anesthesia in the multivariate analysis.

Conclusions

This systematic review of over 50 articles on upper-limb surgery performed under RA shows no association between the incidence of PNI and the location of surgery or type of brachial plexus block.

Type of study/level of evidence

Diagnostic II.

SUBMITTER: Silverstein ML

PROVIDER: S-EPMC9308165 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Peripheral nerve injuries (PNIs) in the upper extremities is an important medical problem, causing significant morbidity at a relatively young age. The epidemiology of PNI in South Korea has not been comprehensively evaluated. The purpose of our study was to examine the incidence of upper extremity PNI in South Korea based on an analysis of nationwide data and to investigate the association between PNI and patients' demographic characteristics. Patient claims data from the Health Insurance Review and Assessment Service from 2008 to 2018 were collected. Demographic characteristics, such as the age, sex, region, admission route, length of hospital stay, healthcare facility level, and cost were evaluated. Annual incidence, body sites affected, damaged nerves, accompanying injuries, and surgical procedures were analyzed. Annual incidence trends, injured anatomical area, seasonal injury trends, and injury trend according to sex were also evaluated. A total of 57,209 cases were identified during the study period. Mean age was 39.7 ± 16.3 years. Of these cases, 51,651 (90.28%) were surgically treated. About 79% of accompanying injuries occurred in the hand area (hand lacerations, 69.5%; fractures or joint dislocations of the hands, 6.86%; crushing injuries of the hands, 2.67%). Overall, injuries to the digital nerve showed the greatest frequency (62.7%). In the upper arm and forearm, the ulnar nerve was most frequently injured; however, in the hand, radial nerve injuries were most common. The annual incidence rate per 100,000 persons decreased from 10.67 in 2008 to 7.88 in 2018. The annual incidence decreased by 0.98 times per year. PNI occurred 33.91 times more frequently in the finger than in the upper arm, and there were 1.16 times more PNIs in the summer and 2.14 times more in men. We investigated the incidence trend and epidemiologic characteristics of upper extremity peripheral nerve injury in South Korea from 2008 to 2018. A decreasing tendency of annual incidence was observed from 2013 onwards. Finger and digital nerve were most commonly injured, and the incidence of PNI was higher in the summer and in men.