Perioperative Neuropathies Associated with Surgical Positioning
Summary
Perioperative neuropathies from surgical positioning are injuries to peripheral nerves arising during the perioperative period as a result of compression, stretch or ischaemia when patients are placed in non-physiological postures on the operating table. These injuries range from transient sensory disturbances to sustained motor deficits and can affect any peripheral nerve, although the ulnar nerve, brachial plexus and lower-limb nerves are most frequently implicated. The incidence varies according to procedure type, duration and positioning technique but remains low. Mechanisms include direct pressure from supports, limb malalignment, prolonged traction and reduced microvascular perfusion. Risk factors encompass extended operative times, extremes of patient habitus, pre-existing neuropathies and immobilisation devices. Preventative strategies comprise anatomically neutral limb placement, adequate padding, intermittent position checks and intraoperative monitoring. Early recognition and management, including neurophysiological assessment and rehabilitation, are crucial to optimise functional recovery. Growing awareness of these complications has driven the development of practice guidelines and novel monitoring approaches to mitigate the global burden of iatrogenic nerve injury in surgery.
Research from Nature Portfolio
No recent Nature Portfolio content available.
Perioperative Neuropathies Associated with Surgical Positioning publication trend
The graph below shows the total number of articles in perioperative neuropathies associated with surgical positioning across all publications each year (not limited to Nature Index journals).
Technical terms
Perioperative neuropathy: Injury to a peripheral nerve occurring during the preoperative, intraoperative or postoperative period due to mechanical or vascular factors.
Trendelenburg position: A surgical posture with the patient supine and the operating table angled so that the head is lower than the feet.
Lithotomy position: A posture in which the patient lies on the back with hips and knees flexed, commonly used in gynaecological and urological surgery.
Brachial plexus: A network of peripheral nerves arising from the spinal roots C5–T1 that innervate the shoulder, arm and hand.
Ulnar neuropathy: Dysfunction of the ulnar nerve, typically manifesting as sensory disturbance or motor weakness in the fourth and fifth fingers and the ulnar side of the hand.
Meralgia paresthetica: Compression-induced neuropathy of the lateral femoral cutaneous nerve, causing pain or numbness in the outer thigh.
References
- Postoperative ulnar neuropathy: a systematic review of evidence with narrative synthesis. British Journal of Anaesthesia (2023).
- Upper extremity contact pressure measurement in robot-assisted pelvic surgery. Journal of Robotic Surgery (2024).
- Patient positioning on the operating table and patient safety: A systematic review and meta‐analysis. Journal of Advanced Nursing (2024).
About these summaries
This Nature Research Intelligence Topic summary is created with the cited references and a large language model. We take care to ground generated text with facts, and have systems in place to gain human feedback on the overall quality of the process in line with our AI principles. We strive to create accurate and useful summaries for people unfamiliar with the research topic and that supports this goal. These pages are a beta release and will be updated as we learn how best to help people gain value from a research topic summary.
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.