ABSTRACT
Common peroneal nerve palsy after surgery with lithotomy position has been widely reported, but it is an unexpected complication after surgery with supine position. We report a patient who developed common peroneal nerve palsy after surgery with supine position. A 55-year old man is planed for robotic assisted laparoscopic right hemicolectomy because of colon cancer. The patient was placed supine with Trendelenburg position at an angle about 5 degrees and tilted left about 15 degrees. The operation is uneventful, but he developed common peroneal nerve palsy on the first postoperative day. The patient was fully recovered with conservative treatment after 2 months. We consider that nerve palsy as a result of compression of common peroneal nerve related to patient positioning. So we should be careful not to develop common peroneal nerve palsy even if the patient was placed in the supine position during robotic assisted surgery.
Subject(s)
Humans , Colonic Neoplasms , Head-Down Tilt , Paralysis , Patient Positioning , Peroneal Nerve , Supine PositionABSTRACT
Motor neuropathy of a lower extremity is well recognized potential complication of procedures performed on patients in a lithotomy position. Mechanisms of nerve injury are unclear but the incidence of perioperative nerve injuries can be reduced if anesthetists are aware of their causes and pathophysiolgies. It is important to note that reduced duration in lithotomy position may reduce the risk of lower extremity neuropathies. We experienced two case of common peroneal nerve palsy after lithotomy positioning. Diagnosis was based on history, a clinical examination and electrophysiologic studies. A neurologic examination revealed hypersthesia over the dorsum of the left foot with inability to perform active dorsiflexion. Electrophysiologic studies showed delayed latency and low amplitude of nerve action potential.
Subject(s)
Humans , Action Potentials , Diagnosis , Foot , Incidence , Lower Extremity , Neurologic Examination , Paralysis , Peroneal NerveABSTRACT
Nerve injury associated with cardiac surgery and anesthesia is a well-recognized complication with a predilection for the upper half of the body. We report four cases of common peroneal nerve palsy following cardiac surgery that were not subject to external compression to fibular head. The diagnosis of nerve palsy was delayed because of a complicated postoperative course and intensive care, which prevented our determining the causes. The mechanisms of nerve injury are reviewed. We postulate that the etiology is multifactorial, including, old age, subnormal body habitus, prolonged knee flexion and rotation, coexisting disease, postoperative cardiovascular complications, and cardiopulmonary bypass.