Neurologic complications in operations performed in the lithotomy position

Park, Eun Kyung; Sin, Woo Mi; Cheon, Keun Young; Lee, Hae Nam

Abstract

OBJECTIVE
Neurologic complication of extremity is well recognized as a potential complication of procedures performed on patients in the lithotomy position. The goal of this study was to evaluate the incidence and risk factors of this complication.
MATERIALS AND METHODS
We retrospectively reviewed the perioperative courses of 322 patients who underwent 1 of 13 surgical procedures performed on patients in the lithotomy position at the A university medical center from 2003 to 2005 inclusive. Neurologic complication was defined as symptoms of paresthesia or dysesthesia (burning) with or without aching pain in the distribution of a extremity nerve or weakness of any extremity muscle, both during postoperative period.
RESULTS
Neurologic complications of extremity developed in 5 patients (1.6%). Unilateral nerve affected in patients as follows: sciatic (four patients), radial (one patient). All patients complained motor weakness and paresthesia. 2 patients with suspicious muscle injury due to compartment syndrome had painful swelling. Symptoms were noted at operative day or first and second postoperative day. These symptoms resolved within 5 months in 4 of 5 patients. Multivariate risk factors for development of neurologic complication included perioperative blood transfusion (r=0.128, P<0.05) and duration in lithotomy (r=0.247, P<0.01)
CONCLUSIONS
In our data, neurologic complications of extremity were infrequent complications that were noted very soon after surgery and anesthesia. Prognosis often was mild and resolved spontaneous, but they could be severe and associate with prolonged disability. The longer patients were positioned in the lithotomy positions, the greater the chance of development of a neurologic complication. The appropriate positioning and reduction of time in the lithotomy position may reduce the risk of neurologic complication.