Complications in nerve surgery
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This document summarizes complications that can occur with nerve surgery and management of Complex Regional Pain Syndrome (CRPS). It outlines possible immediate, early, and late complications from surgery including non-diagnosis, pain, nerve injury, paralysis, sensory loss, and contractures. CRPS is described as having types I and II, and symptoms like pain, swelling, and skin changes. Treatment recommendations include education, physical therapy, pain management, and interventions like spinal cord stimulation.
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Complications in nerve surgery
- 1. Complications in nerve surgery
- 2. At the end of the lecture the participant will be able to: • 1. List the possible complications and describe their prevention and management • 2. Understand and manage complex regional pain syndrome
- 3. Complications • Immediate – as result of surgery • Early – immediate post op period • Late – secondary to nerve regeneration • Secondary effects
- 4. Immediate • Non diagnosis – early/partial • Pain – CRPS • During surgery – iatrogenic injury of nerves and vessels, nerve transfer/graft deficit of donor
- 7. Intermediate • tender neuroma • paralysis, and • incomplete sensory recovery. • degree of cold intolerance • Decreasing functional recovery • Non progressing Tinel
- 8. Late • Dysesthesia and disuse • Surgical failure - tension, technique, poor vascular bed • Contractures • Deformities – claw, Simian hand • Atrophic changes
- 9. 5219 procedures on 1819 patients total complication rate was 2.91% Perioperative complications in patients undergoing peripheral nerve surgery. Ducic I, Hill L, Maher P, Al-Attar A. Ann Plast Surg. 2011 Jan;66(1):69-72.
- 10. Consenting
- 11. Complex regional pain syndrome CRPS • Type I - without a nerve lesion (commonest) • type II – post nerve • Increased sweating, trophic changes, and vasoconstriction • related coldness of the affected limb • long been considered as results of autonomic (sympathetic) hyperactivity • 10% of patients report minor trauma
- 14. Pain Pract. 2009 Mar- Apr;9(2):86-99 Current understandings on complex regional pain syndrome. de Mos M, Sturkenboom MC, Huygen FJ.
- 16. CRPS 1. an inflammatory process 2. sympathetically mediated disorder 3. Central sensitization 4. autoimmune condition 5. limb ischaemia /reperfusion injury 6. Cortical reorganization 7. nerve damage 8. Neurogenic inflammation
- 17. 6 years after disease onset • 30% completely recovered, and • 54% of patients consider their disease as stable • 15% of patients no improvement, • 30% unable to work Outcome of the complex regional pain syndrome. Clin J Pain 2009;25:590 -7de Mos M, et al
- 19. Recommendations for the treatment • Educated and self management • specialized physio /occupational therapy • Multidisciplinary pain management • drug or interventional treatments ( SCS etc) • Perioperative care • Long-term care SCS is the application of an electrical current to the spinal cord dorsal column through a catheter inserted into the epidural space
- 20. References Rheumatology (Oxford). 2011 Oct;50(10):1739-50. Complex regional pain syndrome in adults. Goebel A Harden RN, Bruehl S, Stanton-Hicks M, Wilson PR.Proposed new diagnostic criteria for complex regional pain syndrome. Pain Med 2007;8:32631 Kemler MA, Barendse GA, van Kleef M et al.Spinal cord stimulation in patients with chronic reflex sympathetic dystrophy. N Engl J Med 2000;343:61824. Kingery WS. Role of neuropeptide, cytokine, and growth factor signaling in complex regional pain syndrome. Pain Med 2010;11:123950 Latremoliere A, Woolf CJ. Central sensitization: a generator of pain hypersensitivity by central neural plasticity J Pain 2009;10:895926