Nerve Damage and Chronic Pain following Surgery: Patient Consent

According to information published recently by TMLEP clinical risk and patient safety investigators, doctors should not overlook their duty to inform patients about the risk of nerve damage and long-term pain as a result of surgery. TMLEP is an independent practice comprising leading clinicians and medical experts. The group works in the public and private healthcare sectors to inform clinicians and to improve standards of care.

Nerve damage is a recognised complication that occurs in varying degrees following almost all surgery. Although well documented in major operations, it can (and does) arise after straightforward or relatively simple ones, too. However, experts have noted that in the latter instances, the information supplied to patients and the need to obtain proper consent do not always receive sufficient attention.

Causes of nerve damage

As background, contributory factors include:

  • Inadvertent stretching or compression of the nerves, such as while an individual is unconscious under general anaesthetic.
  • Poor oxygen supply to the nerves, due to blood clots, tourniquet usage, or the insertion of metalwork. Restricted blood flow withholds essential oxygen from the surrounding tissues and nerves.
  • Damage caused by surgical instruments: scalpel incisions, medical equipment used for airway maintenance and ventilation, etc.

Whereas surgery near nerve centres almost always results in chronic pain, unknown and unexpected phenomena can also cause the condition.

Patient expectations

According to the investigators’ findings, more extensive management of expectations was necessary to minimise complaints and compensation claims for persistent pain. Whereas patient consent forms for complex surgical interventions usually listed chronic nerve pain and damage as side effects, it would be essential to ensure the inclusion of the same information for less intricate procedures, they noted.

In particular, it has sometimes not been possible to defend claims against healthcare providers and surgeons when patients have suffered nerve damage or chronic pain after their operations. Indeed, such legal action has prospered even when the problem might have been due to a pre-existing illness or condition – and despite not being directly attributable to complications arising from surgery.

New case law

Evidence of informed patient consent is likely to be increasingly necessary, especially in light of the Supreme Court decision in the case of Montgomery vs Lanarkshire Health Board, 2015. This landmark ruling changed legal precedent; doctors now have to ensure that patients are adequately aware of material risks in proposed treatment(s), along with any reasonable alternatives.