Perioperative Neuropathic Pain— Nerve Sonography for Prevention?

Chronic pain is common and often severely impacts patients' quality of life and ability to work. This results in immense costs for the economy. Pathological findings that can be visualized sonographically in the nerve architecture and a detectable altered nerve course can provide important, previously unrecognized clues to the cause of neuropathic pain. The importance of ultrasound in the assessment of peripheral nerves has been recognized only slowly in recent years. In our Department of  Anesthesiology, Intensive Care, and Pain Therapy at Balgrist University Hospital, diagnostic nerve ultrasound is crucial for evaluating patients with neuropathic pain. Postoperative neuropathic pain can often be caused by nerve irritation or injury in the surgical area, which can be detected sonographically. In the past, the course of individual nerves could not be taken into consideration when choosing surgical access routes. Neither the imaging technology nor the knowledge of how to detect the small cutaneous nerves were available. High-resolution nerve ultrasound can be used not only to assess postoperative neuropathic pain, but also has a great potential for the preoperative identification of individual nerve courses. In an initial study on volunteers, we were able to demonstrate the high variability of the courses of nerves in the lower leg and foot and the risk of their damage by standard surgical approaches. 

In a further study, nerve tracts in patients will be identified and marked on the skin to help foot surgeons adapt their procedures and thus reduce nerve damage and postoperative neuropathic pain.