Meralgia paresthetica following hemorrhoidectomy in the jack-knife position - A case report -

Abstract

Meralgia paresthetica (MP) is a neuropathic pain caused by entrapment of the lateral femoral cutaneous nerve (LFCN), leading to pain, tingling sensation, and numbness in the anterolateral aspect of the thigh. MP has an incidence rate of 4.3 per 10,000 person-years in the general populations. It has been reported to be associated with obesity, diabetes mellitus (DM), prolonged surgical time, and other entrapment etiologies including pregnancy, wearing tight clothes, and leaning against hard objects [1,2]. It is also suspected that these patients develop MP due to direct compression of the LFCN in the prone position. When a hemorrhoid surgery is conducted in the jack-knife position, the weight of the abdominal viscera and adipose tissue may be subject to greater traction forces, resulting in increased compression of the LFCN. MP may develop in severe obese patients even if with short surgical time.To the best of our knowledge, this case report would be the first case of MP due to the jack knife position assumed in hemorrhoid surgery. CASE REPORTA 42-year-old man (height 176 cm; weight 140 kg; body mass index [BMI] 41.6 kg/m 2 ) diagnosed with hemorrhoids, underwent hemorrhoidectomy surgery. The patient had a history of hypertension, diabetes, heart failure, and restless leg syndrome (RLS). He was under treatment with antidepressants, including a selective serotonin receptor inhibitor (SSRI) and benzodiazepines (BZD), along with antihypertensive drugs. Initially, surgery under spinal anesthesia in a jack-knife position was planned. Considering the BMI of the patient, a blind saddle block was attempted; unfortunately, it failed. Following this, an ultrasonography-guided spinal