KEY POINTS

1. Nerve damage was responsible for 16% of the cases in the ASA Closed Claims Database, making it, after death, the second most frequent category of claims for injury.
2. Ulnar nerve injury claims were the most frequent type of nerve damage cases in the ASA Closed Claims Database, followed by claims involving the brachial plexus, lumbosacral nerve roots, and the spinal cord.
3. Prospective studies suggest that postoperative ulnar nerve deficits are not related to patient positioning because they also occur in nonsurgical patients and frequently are not noticed until well into the postoperative period.
4. Brachial plexus injuries occur in cardiovascular surgical cases requiring median sternotomy; they can also be caused when shoulder braces are used for patients tilted in a head-down position.
5. The ASA Task Force on Prevention of Peripheral Neuropathies reported in 1999 that only 6 of the 509 positioning studies it reviewed demonstrated scientifically proven relationships between interventions and outcomes.
6. Three risk factors associated with neuropathies after surgery in lithotomy position are prolonged surgery, very thin body habitus, and recent cigarette smoking.
7. Infarction or ischemia of one or both optic nerves can cause ION, leading to blindness after massive hemorrhage, hypotension, and anemia.