Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves.
The purpose of this study was to determine if various lithotomy positions increase strain on the obturator and lateral femoral cutaneous nerves in fresh adult cadavers. A static load cell was used to record strain changes of the obturator and lateral femoral cutaneous nerves in the pelvis and anterior thigh when the lower limbs were placed in three sets of positions of varying hip abduction and flexion. The means of the strain measurements, which were measured in grams in all positioning angles were compared to the baseline 0 degrees measurements. Analysis of variance was calculated for the differences. Flexion of the hip did not increase strain on either nerve. Abduction to 30 degrees or 45 degrees increased strain by more than 30 g on the obturator nerve (P < 0.05) but not the lateral femoral cutaneous nerve. The addition of 45 degrees or more of flexion to abduction negated the strain increase on the obturator nerves seen with abduction alone. Nerve strain >30 g has been associated consistently with nerve dysfunction, disrupting axonal transmission, and causing structural neural damage. Our findings suggest that concomitant hip flexion should be used when placing anesthetized patients in a lithotomy position that includes abduction of the lower limbs to >30 degrees to decrease the risk for perioperative neuropathy of the obturator nerve.
Litwiller
Jonathan P
JP
Department of Anesthesiology, Mayo Medical School, Rochester, Minnesota 55905, USA.
Wells
Robert E
RE
Halliwill
John R
JR
Carmichael
Stephen W
SW
Warner
Mark A
MA
D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005260:Female; D005267:Femoral Nerve / Q000293:injuries / Q000473:pathology*; D006801:Humans; D035002:Lower Extremity; D008875:Middle Aged; D009776:Obturator Nerve / Q000293:injuries / Q000473:pathology*; D010149:Postoperative Pain / Q000517:prevention & control; D010388:Pelvis / Q000601:surgery; D011187:Posture; D013180:Sprains and Strains / Q000517:prevention & control*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*