Abstract
We describe a case in which an anatomic diagnosis was useful for diagnosing and estimating the cause of femoral nerve palsy following gynecologic surgery. A 49-year-old female received general and epidural anesthesia for radical ovarian cancer surgery. Although injection pain was noted in the left medial shin with 1 % mepivacaine administered as a test dose, the catheter was left indwelling because it improved her symptoms. The surgery, which lasted 195 min, was performed in the lithotomy position, and a self-retained retractor was used to gain a good surgical field. Postoperatively, the patient complained of difficulty in stretching her knee joint and left lower limb paresthesia that did not improve after stopping continuous epidural administration. A spinal cord injury related to epidural anesthesia was suspected because the sites of sensory impairment and epidural injection pain were the same; however, the patient had greater weakness of the quadriceps muscle than the iliopsoas, and no other muscle weakness was observed. These findings and previous reports suggest that her femoral nerve palsy was caused by compression of the inguinal ligament from the self-retaining retractor and lithotomy position. Twenty months after surgery, her muscle strength had fully recovered.
Similar content being viewed by others
References
Kvist-Poulsen H, Borel J. Iatrogenic femoral neuropathy subsequent to abdominal hysterectomy: incidence and prevention. Obstet Gynecol. 1982;60:516–20.
Goldman JA, Feldberg D, Dicker D, Samuel N, Dekel A. Femoral neuropathy subsequent to abdominal hysterectomy. A comparative study. Eur J Obstet Gynecol Reprod Biol. 1985;20:385–92.
Mayall MF, Calder I. Spinal cord injury following an attempted thoracic epidural. Anaesthesia. 1999;54:990–4.
Kang XH, Bao FP, Xiong XX, Li M, Jin TT, Shao J, Zhu SM. Major complications of epidural anesthesia: a prospective study of 5083 cases at a single hospital. Acta Anaesthesiol Scand. 2014;58:858–66.
Holdsworth F. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am. 1970;52:1534–51.
Irvin W, Andersen W, Taylor P, Rice L. Minimizing the risk of neurologic injury in gynecologic surgery. Obstet Gynecol. 2004;103:374–82.
Maneschi F, Nale R, Tozzi R, Biccire D, Perrone S, Sarno M. Femoral nerve injury complicating surgery for gynecologic cancer. Int J Gynecol Cancer. 2014;24:1112–7.
Huang WS, Lin PY, Yeh CH, Chin CC, Hsieh CC, Wang JY. Iatrogenic femoral neuropathy following pelvic surgery: a rare and often overlooked complication–four case reports and literature review. Chang Gung Med J. 2007;30:374–9.
Tondare AS, Nadkarni AV, Sathe CH, Dave VB. Femoral neuropathy: a complication of lithotomy position under spinal anaesthesia. Report of three cases. Can Anaesth Soc J. 1983;30:84–6.
Upton AR, McComas AJ. The double crush in nerve entrapment syndromes. Lancet. 1973;2:359–62.
Sorenson EJ. Neurological injuries associated with regional anesthesia. Reg Anesth Pain Med. 2008;33:442–8.
Horlocker TT, Cabanela ME, Wedel DJ. Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty? Anesth Analg. 1994;79:495–500.
O’Neill T, Cuignet-Royer E, Lambert M, Cornet C, Bouaziz H. Perioperative ulnar neuropathy following shoulder surgery under combined interscalene brachial plexus block and general anaesthesia. Eur J Anaesthesiol. 2008;25:1033–6.
Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007;104:965–74.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Watanabe, T., Sekine, M., Enomoto, T. et al. The utility of anatomic diagnosis for identifying femoral nerve palsy following gynecologic surgery. J Anesth 30, 317–319 (2016). https://doi.org/10.1007/s00540-015-2113-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00540-015-2113-x