Muhammed Cihan TEMEL, Serkan AKAN, Caner EDİZ, Omer YİLMAZ

Hyperbaric oxygen therapy in peroneal nerve damage due to lithotomy position

Peripheral neuropathies can be seen in patients who are operated in lithotomy position. In this case report, patient which had right drop foot after urethroplasty surgery in lithotomy position was treated. Electromyography (EMG) was performed at postoperative 1st day and demonstrated right peroneal nerve palsy. Physiotherapy (knee extension, cycling, and passive dorsiflexion), vitamin B complex (B1, B6, folic acid and B12) and daily hyperbaric oxygen treatment were started. Fifth day after surgery, improvement of moving the right foot was detected clinically. Patient was discharged on 7th postoperative day and neurologist suggested to continue physiotherapy and vitamin B complex for 3 weeks. After this period, control EMG showed the development of peroneal nerve functions. The patient had a fully functional right foot with all these treatments one month after surgery. Effectivity of hyperbaric oxygen in treatment of peripheral nerve degeneration was seen in several studies in literature (4). In a few studies, the effect of hyperbaric oxygen on peroneal nerve palsy has not been demonstrated (5). The patient recovered earlier than other patients in literature. In this case, the treatment difference was hyperbaric oxygen treatment from other cases in literature. Before the start of lithotomy operations, patients should be carefully evaluated for peroneal nerve palsy risk factors and appropriately positioned to prevent iatrogenic peroneal nerve palsy in the operation. After operation, if peroneal nerve palsy develops, physiotherapy should start as soon as possible. Hyperbaric oxygen is kept in mind as supplemental treatment even if it is not in standard treatment protocol in peroneal nerve palsy.

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1. Mizuno J, Takahashi T. Factors that increase external pressure to the fibular head region, but not medial region, during use of a knee-crutch/leg-holder system in the lithotomy position. Ther Clin Risk Manag 2015;11:255-61.
2. Warner MA, Martin JT, Schroeder DR, et al. Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position. Anesthesiology 1994;81:6-12.
3. Nonthasoot B, Sirichindakul B, Nivatvongs S, et al. Common peroneal nerve palsy: an unexpected complication of liver surgery. Transplant Proc 2006;38:1396- 7.
4. Bajrovic FF, Sketelj J, Jug M, et al. The effect of hyperbaric oxygen treatment on early regeneration of sensory axons after nerve crush in the rat. J Peripher Nerv Syst 2002;7:141-8.
5. Santos PM, Zamboni WA, Williams SL, et al. Hyperbaric oxygen treatment after rat peroneal nerve transection and entubulation. Otolaryngol Head NeckSurg 1996;114:424-34.
6. Barnett JC, Hurd WW, Rogers RM Jr, et al. Laparoscopic positioning and nerve injuries. J Minim Invasive GynecoL 2007;14:664-72.
7. Mizuno J, Namba C, Takahashi T. Measurement of external pressure of peroneal nerve tract coming in contact with lithotomy leg holders using pressure distribution measurement system BIG-MAT®. Masui. 2014; 63:1167-71.
8. Warner MA, Warner DO, Harper CM, et al. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000;93:938-42.
9. Koç G, Tazeh NN, Joudi FN, et al. Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table. J Endourol 2012;26:1026-9.
10. Irvin W, Andersen W, Taylor P, et al. Minimizing the risk of neurologic injury in gynecologic surgery. Obstet Gynecol 2004;103:374-82.
11. Topuz K, Colak A, Cemil B, et al. Combined hyperbaric oxygen and hypothermia treatment on oxidative stress parameters after spinal cord injury: an experimental study. Arch Med Res 2010;41:506-12.
12. Sanchez EC. Hyperbaric oxygenation in peripheral nerverepair and regeneration. Neurol Res 2007;29:184-98.