Types of intraoperative positioning nerve injuries


  • Mohammed F. Qaffas Department of General Surgery, Al Thager Hospital, Jeddah, Saudi Arabia
  • Ahmad S. Alrefaie Department of Urology, King Abdullah Medical Complex, Jeddah, Saudi Arabia
  • Sultan S. Algadheeb College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
  • Fatemah M. Aldabbous Department of General Surgery, Al Adan Hospital – Ministry of Health Kuwait, Fahaheel, Kuwait
  • Roaa A. Alkanderi Kuwait Institute for Medical Specializations, Kuwait City, Kuwait
  • Qanot N. Alshatti College of Medicine and Medical Science, Arabian Gulf University, Manama, Bahrain
  • Lina A. Altalhi College of Medicine and Medical Science, Arabian Gulf University, Manama, Bahrain
  • Hamza M. Elabbasy College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  • Abdullah A. Alhussain College of Medicine, Almaarefa University, Riyadh, Saudi Arabia
  • Abdullatif M. Alghamdi Department of Anesthesia, King Abdulaziz Hospital, Jeddah, Saudi Arabia
  • Maan H. Agil Department of General Surgery, Security Forces Hospital, Mecca, Saudi Arabia
  • Abdulelah W. Bakhsh Department of General Surgery, Al Thager Hospital, Jeddah, Saudi Arabia




Nerve injury, Surgical procedures, Intraoperative positioning


Intraoperative positioning nerve injuries are a known complication that can occur during surgical procedures when patients are placed in specific positions on the operating table. The causes of intraoperative positioning nerve injuries are multifactorial and are associated with aspects related to how the patient is positioned during the surgical procedure and the duration for which pressure or tension is applied to nerves. This study was conducted to identify and categorize the various types of intraoperative positioning nerve injuries and to establish prognostic classifications for these injuries. The aim was to address the imperative need for strategies to prevent and manage such injuries effectively. The study involved an extensive review of existing literature, encompassing databases such as PubMed, Web of Science, and Cochrane. Intraoperative positioning nerve injuries can be categorized based on several parameters, including the nature of the injury, the specific nerve or nerve plexus affected, and the severity of the damage incurred. Two major classification systems based on injury extent are Seddon’s and Sunderland’s classifications. Types based on anatomical region can be loosely divided into nerves present in the upper limb, lower limb, head and neck, and thoracic region. The prevention of intraoperative positioning nerve injuries is of paramount importance and hinges on meticulous preoperative planning, the utilization of appropriate positioning techniques, and the diligent monitoring of patients throughout the surgery.


Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CP, Richter H-P. Iatrogenic nerve injuries: prevalence, diagnosis and treatment. Deutsches Ärzteblatt Int. 2014;111(16):273.

Lalkhen AG. Chapter 37 - Perioperative Peripheral Nerve Injuries Associated with Surgical Positioning. In: Tubbs RS, Rizk E, Shoja MM, Loukas M, Barbaro N, Spinner RJ, eds. Nerves and Nerve Injuries. San Diego: Academic Press. 2015:587-602.

Prielipp RC, Morell RC, Butterworth J. Ulnar nerve injury and perioperative arm positioning. Anesthesiology Clin North Am. 2002;20(3):589-603.

Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol. 2005;63(1):5-18.

Sawyer R, Richmond M, Hickey J, Jarrratt J. Peripheral nerve injuries associated with anaesthesia. Anaesthesia. 2000;55(10):980-91.

Welch MB, Brummett CM, Welch TD. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. J Am Soc Anesthesiol. 2009;111(3):490-7.

Lalkhen AG, Bhatia K. Perioperative peripheral nerve injuries. Continuing Education in Anaesthesia Crit Care Pain. 2011;12(1):38-42.

Warner MA, Warner ME, Martin JT. Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology. 1994;81(6):1332-40.

Warner MA, Warner DO, Harper CM, Schroeder DR, Maxson PM. Ulnar neuropathy in medical patients. J Am Soc Anesthesiol. 2000;92(2):613.

Seddon H. Three types of nerve injury. Brain. 1943;66(4):237-88.

Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain. 1951;74(4):491-516.

Biso GMNR, Munakomi S. Neuroanatomy, neurapraxia. In: StatPearls. StatPearls Publishing. 2022.

Goubier J-N, Teboul F. Grading of nerve injuries. In: Nerves and nerve injuries. Elsevier. 2015:603-10.

Sonabend AM, Smith P, Huang JH, Winfree C. Chapter 195 - Peripheral Nerve Injury. In: Quiñones-Hinojosa A, ed. Schmidek and Sweet Operative Neurosurgical Techniques (Sixth Edition). Philadelphia: W.B. Saunders. 2012:2225-38.

Chui J, Murkin JM, Posner KL, Domino KB. Perioperative Peripheral Nerve Injury After General Anesthesia: A Qualitative Systematic Review. Anesth Anal. 2018;127(1):134-43.

Hewson D, Bedforth N, Hardman J. Peripheral nerve injury arising in anaesthesia practice. Anaesthesia. 2018;73:51-60.

Barner KC, Landau ME, Campbell WW. A review of perioperative nerve injury to the upper extremities. J Clin Neuromuscular Dis. 2003;4(3):117-23.

Chung I, Glow JA, Dimopoulos V. Upper-limb somatosensory evoked potential monitoring in lumbosacral spine surgery: a prognostic marker for position-related ulnar nerve injury. Spine J. 2009;9(4):287-95.

Barnett JC, Hurd WW, Rogers RM, Williams NL, Shapiro SA. Laparoscopic positioning and nerve injuries. J Minim Invasive Gynecol. 2007;14(5):664-72.

Dillavou ED, Roderick Anderson L, Bernert RA. Lower extremity iatrogenic nerve injury due to compression during intraabdominal surgery. Am J Surg. 1997;173(6):504-8.

Solomons JNT, Sagir A, Yazdi C. Meralgia Paresthetica. Current Pain and Headache Reports. 2022;26(7):525-31.

Barner KC, Landau ME, Campbell WW. A Review of Perioperative Nerve Injury to the Lower Extremities: Part I. J Clin Neuromusc Dis. 2002;4(2):95-9.

Yang J, Qin B, Fu G. Modified pathological classification of brachial plexus root injury and its MR imaging characteristics. J Reconstructive Microsurg. 2013;171-8.

Lorei MP, Hershman EB. Peripheral nerve injuries in athletes: treatment and prevention. Sports Med. 1993;16:130-47.

Giannini F, Cioni R, Mondelli M. A new clinical scale of carpal tunnel syndrome: validation of the measurement and clinical-neurophysiological assessment. Clinical Neurophysiol. 2002;113(1):71-7.

Goldberg BJ, Light TR, Blair SJ. Ulnar neuropathy at the elbow: results of medial epicondylectomy. J Hand Surg. 1989;14(2):182-8.

Practice advisory for the prevention of perioperative peripheral neuropathies: an updated report by the American Society of Anesthesiologists Task Force on prevention of perioperative peripheral neuropathies. Anesthesiology. 2011;114(4):741-54.

Kumar A, Shukla D, Bhat DI, Devi BI. Iatrogenic peripheral nerve injuries. Neurol India. 2019;67(7):135.

Martins RS, Siqueira MG. Peripheral Nerve Surgery. In: Joaquim AF, Ghizoni E, Tedeschi H, Ferreira MAT, eds. Fundamentals of Neurosurgery: A Guide for Clinicians and Medical Students. Cham: Springer International Publishing. 2019;201-9.

Fernandez CE, Franz CK, Ko JH, Walter JM, Koralnik IJ, Ahlawat S, et al. Imaging review of peripheral nerve injuries in patients with COVID-19. Radiology. 2021;298(3):E117-30.




How to Cite

Qaffas, M. F., Alrefaie, A. S., Algadheeb, S. S., Aldabbous, F. M., Alkanderi, R. A., Alshatti, Q. N., Altalhi, L. A., Elabbasy, H. M., Alhussain, A. A., Alghamdi, A. M., Agil, M. H., & Bakhsh, A. W. (2023). Types of intraoperative positioning nerve injuries. International Journal Of Community Medicine And Public Health, 10(10), 3915–3920. https://doi.org/10.18203/2394-6040.ijcmph20233132



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