Nerve injury at abdominal hysterectomy

Morgan, Kim; Thomas, Eric J.

doi:10.1111/j.1471-0528.1995.tb11409.x

Cited by 12 publications

(7 citation statements)

References 2 publications

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“…A British prospective study with 100 patients who underwent total abdominal hysterectomy tried to analyze the disparity between the reported incidence by Kvist-Poulsen and Borel and the real incidence, since there was only one case in the United Kingdom. Seven patients presented clinical evidence of nerve lesion, and the investigation demonstrated there was a lesion of the lateral femoral cutaneous nerve, at the level of the Balfour retractor, in six patients as a complication of the surgery 17 .…”

Section: Discussionmentioning

confidence: 99%

“…Small branches of this nerve can puncture the inguinal ligament, and the hyperflexion of the thigh over the abdomen can increase the pressure on the ligament 16 . There are three predisposing factors for the lesion: Plannenstiel incision, slender build, and the need to apply greater pressure on the retractors used to better expose the surgical field, causing direct nerve compression 7,13,17,18 . The neuromuscular blockade and inadequate positioning of the patient also contribute to the pathogenesis 4,16 .…”

Section: Discussionmentioning

confidence: 99%

“…Um estudo prospectivo britânico com 100 pacientes submetidas a histerectomia total abdominal tentou analisar a disparidade entre a incidência relatada por Kvist-Poulsen e Borel e a incidência real, uma vez que havia apenas um úni-co relato de caso no Reino Unido. Sete pacientes apresentaram evidência clínica de lesão nervosa, e, o estudo revelou lesão de nervo cutâneo femoral lateral da coxa em seis pacientes, como complicação desse procedimento cirúrgico, no qual o afastador de Balfour foi utilizado 17 . Os afastadores estáticos ao realizarem pressão contínua no músculo íleopsoas estiram o nervo femoral e o tornam isquêmico por oclusão da artéria ilíaca externa ou comprimem vasos sangüíneos com íntima relação com o nervo ao passarem através do músculo.…”

Section: Relato Do Casounclassified

“…Pequenos ramos deste podem perfurar o ligamento inguinal e a hiperflexão do quadril sobre o abdômen pode aumentar a pressão dentro do ligamento 16 . Três fatores são apontados como predisponentes para a lesão: a incisão de Pfannenstiel, biotipo magro e a necessidade de aplicação de maior pressão nos afastadores utilizados para melhor exposição do campo cirúrgico, com compressão nervosa direta 7,13,17,18 . Ainda contribuem para a patogênese da lesão, o bloqueio neuromuscular e o posicionamento inadequado da paciente 4,16 .…”

Section: Relato Do Casounclassified

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Plexopatia lombar após histerectomia abdominal: relato de caso

Silva¹,

Resende²,

Pantoja³

et al. 2006

Rev. Bras. Anestesiol.

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Rev Bras AnestesiolINFORMAÇÃO CLÍNICA 2006; 56: 6: 643-648 CLINICAL REPORT RESUMO Silva EV, Resende MAC, Pantoja A, Carvalho ABRF, Silva AB, Cardoso FA -Plexopatia Lombar após Histerectomia Abdominal. Relato de Caso. JUSTIFICATIVA E OBJETIVOS:As lesões neurológicas diagnosticadas no período pós-operatório muitas vezes são atribuídas ao ato anestésico, embora possam também decorrer do ato cirúrgi-co. O objetivo deste relato foi apresentar o caso de uma paciente submetida à intervenção cirúrgica pélvica que evoluiu com quadro de plexopatia lombar e discutir as possíveis causas. RELATO DO CASO:Paciente do sexo feminino, 38 anos, 58 kg, 1,63 m de altura, estado físico ASA I, internada para tratamento de leiomiomatose uterina, com indicação de histerectomia total abdominal. A monitorização inicial incluiu oxímetro de pulso, pressão arterial não-invasiva, eletrocardioscópio e diurese. Após punção venosa no membro superior esquerdo com cateter 18G, foram administrados, por via venosa, cefazolina (2 g), dipirona (2 g), dexametasona (10 mg) e metoclopramida (10 mg). A anestesia peridural foi realizada com agulha Tuohy 16G, no espaço L 3 -L 4 , na linha mediana com a paciente em decúbito lateral esquerdo. Foram administrados 15 mL de ropivacaína a 0,75% e 2 mg de morfina, a seguir posicionado cateter para analgesia pós-operatória. A intervenção cirúrgica não teve intercorrência, mantendo-se a paciente estável sob o ponto de vista cardiovascular. Na visita pós-anestésica, oito horas após o procedimento, a paciente não deambulava e apresentava monoparesia no membro inferior esquerdo. Após investigações clínicas e radiológicas foi descartada a hipótese diagnóstica de síndrome radicular. Como não houve regressão do quadro, 30 dias após foi realizada eletroneuromiografia que foi compatível com plexopatia lombar de possível origem traumática. CONCLUSÕES:O anestesiologista deve estar atento às complicações neurológicas que podem surgir no pós-operatório, participando da elucidação das causas, do tratamento e da sua evolução.Unitermos: COMPLICAÇÕES, Neurológica: plexopatia lombar; TÉC-NICAS ANESTÉSICAS, Regional: peridural contínua. SUMMARYSilva EV, Resende MAC, Pantoja A, Carvalho ABRF, Silva AB, Cardoso FA -Lumbar Plexopathy after Abdominal Hysterectomy. Case Report. BACKGROUND AND OBJECTIVES:Very often, neurological injuries diagnosed postoperatively are attributed to the anesthesia, but they can also be secondary to the surgery itself. The aim of this report was to present the case of a patient who underwent a pelvic surgery and developed lumbar plexopathy, and to discuss the possible causes. CASE REPORT:A woman patient, 38 years old, 58 kg, 1.63 m, physical status ASA I, was admitted to undergo a total abdominal hysterectomy for treatment of uterine leiomyomatosis. Initial monitoring included pulse oxymetry, non-invasive blood pressure, electrocardioscope, and urine output. After venous cannulation in the left upper limb with an 18G catheter, cefazoline (2 g), dypirone (2 g), dexamethasone (10 mg), and metochlopramide (10 ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Relato Do Casounclassified

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Plexopatia lombar após histerectomia abdominal: relato de caso

Silva¹,

Resende²,

Pantoja³

et al. 2006

Rev. Bras. Anestesiol.

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“…33 The femoral nerve is formed from the posterior divisions of L2-4; it emerges lateral to the psoas muscle and then passes under the inguinal ligament to reach the anterior thigh. It provides efferent innervation to the quadriceps femoris, sartorius, iliacus, and pectineus muscles and afferent innervation to the anterior thigh.…”

Section: Anatomy and Preventionmentioning

confidence: 99%

Intraoperative Injury in Reconstructive Pelvic Surgery

Khan¹,

Kenton²

2006

Journal of Pelvic Medicine and Surgery

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Applying graph theory to improve the quality of scientific evidence from textual information: Neural injuries after gynaecologic pelvic surgery for genital prolapse and urinary incontinence

Indraccolo¹,

Losavio

Carone

2023

Neurourology and Urodynamics

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To provide the overall rate for all types of neurologic iatrogenic injuries during urogynaecologic surgery from textual data. Methods: Systematic research focused on complications of gynaecologic surgery and neurologic injuries in abstracts. Keywords concerning complications (cluster A), unspecific; neurologic issues (cluster B); surgery (generic words) (cluster C); specific gynaecologic operations (cluster D); and specific gynaecologic operations for pelvic organ prolapse and urinary incontinence (cluster E) were extracted. Associations among clusters of keywords were assessed by using multiple runs of text-mining software Semantic Brand Score (SBS, https://semanticbrandscore.com/#primary). Association scores were converted into probabilities. The rate of neurologic complications in urogynaecologic surgery was calculated ("a priori" probability) by applying Bayes' theorem. Textual estimates of neurological injuries in urogynaecologic surgery are 0.035554 (95% confidence intervals 0.019607−0.0515001; no quantitative data were found). To test if the probability calculated on textual information was the same as quantitative data reports ("a posteriori" probability), the rate of neurologic complication of all gynaecologic surgery was calculated using a meta-analytics approach and was compared with the textual analysis value. Results: The rate of neurologic complications in gynaecologic surgery after meta-analytic data synthesis has been 0.016489 (95% confidence intervals 0.012163−0.022320), which is equal to the textual estimate (0.016889, 95% confidence intervals 0.019607−0.051501). Therefore, 0.035554 is a reliable likelihood to observe a neurologic complication in urogynaecologic surgery. Conclusion: Iatrogenic nerve injuries in urogynaecologic surgery are higher than whole gynaecologic surgery. Text-mining software SBS and probability conversion can provide reliable answers from overall scholars' opinions on unsolved clinical questions when better evidence is lacking.

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Nerve injury at abdominal hysterectomy

Cited by 12 publications

References 2 publications

Plexopatia lombar após histerectomia abdominal: relato de caso

Plexopatia lombar após histerectomia abdominal: relato de caso

Intraoperative Injury in Reconstructive Pelvic Surgery

Applying graph theory to improve the quality of scientific evidence from textual information: Neural injuries after gynaecologic pelvic surgery for genital prolapse and urinary incontinence

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