title: The utility of anatomic diagnosis for identifying femoral nerve palsy following gynecologic surgery.
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.
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan. tatsu-w@med.niigata-u.ac.jp.
authors.forename: Tatsunori
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Sekine
authors.affiliation: Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Enomoto
authors.affiliation: Division of Anesthesiology, Niigata University Graduate School of Medical and Dental Sciences, Asahimachi 1-757, Chuo-ku, Niigata, 951-8510, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Baba
mesh_terms: D000767:Anesthesia, Epidural / Q000009:adverse effects; D005260:Female; D005267:Femoral Nerve / Q000293:injuries*; D020428:Femoral Neuropathy / Q000209:etiology*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007719:Knee Joint / Q000473:pathology; D007866:Leg; D008619:Mepivacaine / Q000008:administration & dosage; D008875:Middle Aged; D011184:Postoperative Period
chemical_list: D008619:Mepivacaine
keywords: Anatomic diagnosis; Femoral nerve palsy; Self-retained retractor