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Wang S, Xia D, Song D, Lu N, Chen A. Could nerve transplantation be the future of this field: a bibliometric analysis about lumbosacral plexus injury. Int J Surg 2024; 110:3734-3744. [PMID: 38518081 PMCID: PMC11175794 DOI: 10.1097/js9.0000000000001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/04/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Lumbosacral plexus injury is a highly distressing clinical issue with profound implications for patients' quality of life. Since the publication of the first relevant study in 1953, there has been very limited progress in basic research and clinical treatment in this field, and the developmental trajectory and research priorities in this field have not been systematically summarized using scientific methods, leaving the future direction of this research to be explored. METHODS Utilizing publications from the Web of Science (WoS) database, our research employed bibliometric methodology to analyze the fundamental components of publications, synthesize research trends, and forecast future directions. RESULTS A total of 150 publications were included in our study, and the impressive advancement of research heat in this field can be attributed to the continuous increase in the number of papers, ranging from 14 papers in 2000 to 34 papers in 2023 over 5 years. Regarding the country, a central position in both quantity (H-index=125) and quality of publications (65 publications) is occupied by the United States, and close collaborations with other countries are observed. In terms of publication institutions, the highest number of publications (nine publications) is held by the Second Military Medical University. The journal with the most publications (five publications) is the Journal of Trauma-Injury Infection and Critical Care. A pivotal role has been played by basic medical research in the development of this field. Concerning hotspots, the focus of the research core can be divided into three clusters (etiology, diagnosis and treatment; molecular, cells and mechanisms; physiology, and pathology). CONCLUSION This marks the inaugural bibliometric analysis of lumbosacral plexus injuries, offering a comprehensive overview of current publications. Our findings illuminate future research directions, international collaborations, and interdisciplinary relationships. Future research will emphasize clinical treatment and mechanism research, with a focus on sacral nerve stimulation and nerve transplantation.
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Affiliation(s)
- Sheng Wang
- Department of Traumatic Orthopedics, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University
| | - Demeng Xia
- Department of Pharmacy, Seventh People’s Hospital of Shanghai University of Traditional Chinese Medicine
| | - Danyan Song
- Emergency Department, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Nan Lu
- Department of Traumatic Orthopedics, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University
| | - Aimin Chen
- Department of Traumatic Orthopedics, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University
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Barcellini A, Cassani C, Orlandi E, Nappi RE, Broglia F, Delmonte MP, Molinelli S, Vai A, Vitolo V, Gronchi A, D'Ambrosio G, Cobianchi L, Fiore MR. Is motherhood still possible after pelvic carbon ion radiotherapy? A promising combined fertility-preservation approach. TUMORI JOURNAL 2024; 110:132-138. [PMID: 38183176 DOI: 10.1177/03008916231218794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
INTRODUCTION Preserving the endocrine and reproductive function in young female cancer patients undergoing pelvic radiation is a significant challenge. While the photon beam radiation's adverse effects on the uterus and ovaries are well established, the impact of pelvic carbon ion radiotherapy on women's reproductive function is largely unexplored. Strategies such as oocyte cryopreservation and ovarian transposition are commonly recommended for safeguarding future fertility. METHODS This study presents a pioneering case of successful pregnancy after carbon ion radiotherapy for locally advanced sacral chondrosarcoma. RESULTS A multidisciplinary approach facilitated the displacement of ovaries and uterus before carbon ion radiotherapy, resulting in the preservation of endocrine and reproductive function. CONCLUSION The patient achieved optimal oncological response and delivered a healthy infant following the completion of cancer treatment.
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Affiliation(s)
- Amelia Barcellini
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | - Chiara Cassani
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Unit of Obstetrics and Gynecology, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Ester Orlandi
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Rossella E Nappi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Research Center for Reproductive Medicine, Gynecological Endocrinology and Menopause, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Federica Broglia
- Department of Anesthesia and Intensive Care, Unit of Obstetric Anesthesia, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Maria Paola Delmonte
- Department of Anesthesia and Intensive Care, Unit of Obstetric Anesthesia, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Silvia Molinelli
- Medical Physics Unit, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Alessandro Vai
- Medical Physics Unit, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Viviana Vitolo
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Gioacchino D'Ambrosio
- Department of Molecular Medicine, Anatomic Pathology Unit, University of Pavia and Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
| | - Lorenzo Cobianchi
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Department of General Surgery, Foundation IRCCS Polyclinic San Matteo, Pavia, Italy
- ITIR-Institute for Transformative Innovation Research, University of Pavia, Pavia, Italy
| | - Maria Rosaria Fiore
- Radiation Oncology Unit, Clinical Department, CNAO National Center for Oncological Hadrontherapy, Pavia, Italy
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Moita Gonçalves E, Lanzaro C, Silva LC, Correia P, Gonçalves JV, Azevedo M, Carrapatoso I, Silva JP, Carvalho C, Cruz A. Enhancing functional recovery following postpartum femoral neuropathy: early neurorehabilitation and multidisciplinary obstetric care. Int J Gynaecol Obstet 2024; 164:830-834. [PMID: 37537869 DOI: 10.1002/ijgo.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/26/2023] [Accepted: 07/11/2023] [Indexed: 08/05/2023]
Abstract
Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.
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Affiliation(s)
- Eugénio Moita Gonçalves
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
- Egas Moniz Health Alliance Clinical Academic Center, Aveiro, Portugal
| | - Camile Lanzaro
- Anesthesiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Luísa Cunha Silva
- Gynecology and Obstetrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Pedro Correia
- Neurology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - José Vítor Gonçalves
- Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia-Espinho, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Marta Azevedo
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Inês Carrapatoso
- Anesthesiology Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - João Pedro Silva
- Gynecology and Obstetrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Carolina Carvalho
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - André Cruz
- Physical Medicine and Rehabilitation Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
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Boutros N, Saba D, Trikamji B. Postpartum Sciatic Neuropathy After Uncomplicated Vaginal Delivery. Neurohospitalist 2023; 13:429-433. [PMID: 37701248 PMCID: PMC10494828 DOI: 10.1177/19418744231180939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Postpartum neuropathies are common, including femoral neuropathy, peroneal neuropathy, lumbosacral trunk plexopathy, and lateral femoral cutaneous neuropathy. Sciatic mononeuropathy in the peripartum period is rare. Postpartum sciatic neuropathy (PSN) in the setting of cesarean section has been reported before. We present a case series of 2 sciatic mononeuropathies after vaginal delivery. Case 1 is a 25-year-old woman who presented with a left foot drop after normal vaginal delivery after being in labor for 3 hours. Case 2 is a 24-year-old woman who presented with a right foot drop after normal vaginal delivery and being in labor for 31 hours. Both cases noted foot drops in the immediate postpartum period. Neurologic examinations revealed flail foot, 4/5 hamstring muscle strength on MRC scale and intact hip abduction. They had paresthesia on the posterolateral aspect of the leg, dorsal and plantar aspect of the foot with absent ankle reflex. MRI did not show evidence of spinal cord, nerve root or plexus involvement. Electrodiagnostic studies revealed evidence of sciatic mononeuropathy proximal to the short head of biceps femoris. They were discharged home with an ankle brace and therapy. At 3 months follow up, they had complete resolution of weakness. There have been a few reported cases of PSN secondary to cesarean section. Sciatic involvement after vaginal delivery is extremely rare. We report 2 cases of PSN after vaginal delivery to highlight that sciatic mononeuropathy can occur not only after cesarean section, but also after uncomplicated vaginal delivery and should raise awareness of this risk to clinicians.
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Affiliation(s)
- Nader Boutros
- Department of Neurology, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Dina Saba
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Bhavesh Trikamji
- Department of Neurology, University of California Riverside School of Medicine, Riverside, CA, USA
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Pirenne V, Dewinter G, Van de Velde M. Spinal Anesthesia in Obstetrics. Best Pract Res Clin Anaesthesiol 2023. [DOI: 10.1016/j.bpa.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
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Tournier A, Doremieux AC, Drumez E, Labreuche J, Cassim F, Gonzales M, Garabedian C, Subtil D. Factors associated with a maternal lower-limb neurological deficit after vaginal delivery. Acta Obstet Gynecol Scand 2023; 102:51-58. [PMID: 36225122 PMCID: PMC9780720 DOI: 10.1111/aogs.14441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The etiology of lower-limb neurological deficit after vaginal delivery remains poorly understood. The objective herein was to identify factors associated with this maternal nerve injury after vaginal delivery. MATERIAL AND METHODS A single-center, case-control (matching 1:4) study. Cases were women with a lower-limb neurological deficit that appeared immediately after vaginal delivery. Controls were randomly selected women who gave birth vaginally during the same period, without any deficit. Finally, to assess the rates of factors associated with these deficits, we studied them using a randomly selected 5% sample of the population with vaginal deliveries. RESULTS During the 30-month study period, 31 cases were identified among 10 333 women who gave birth vaginally (0.3%, 95% CI 0.20-0.43); 124 controls were also included. After logistic regression, the presence of a neurological deficit after delivery was associated with second-stage labor duration (per hour odds ratio [OR] 3.67, 95% CI 2.09-6.44; OR per standard deviation increase 2.73, 95% CI 1.75-4.25, p < 0.001) and instrumental delivery (OR = 3.24, 95% CI 1.29-8.14, p = 0.012), with no interaction effect (p = 0.56). Extrapolation of these factors to a 5% sample of the overall population of women with vaginal births showed that the rate of these deficits would be very low for women with second-stage labor lasting up to 90 min without instrumental delivery (0.05%) but increased to 1.52% when these factors were combined (OR 33.1, 95% CI 9.4-116.9). CONCLUSIONS Following vaginal delivery, the onset of a neurological deficit is principally associated with the duration of second-stage labor and instrumental delivery.
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Affiliation(s)
- Alexane Tournier
- Women and Newborn Mother UnitCentre Hospitalier Universitaire de Lille, Université LilleLilleFrance
| | - Anne Cecile Doremieux
- Women and Newborn Mother UnitCentre Hospitalier Universitaire de Lille, Université LilleLilleFrance
| | - Elodie Drumez
- EA 2694, METRICS, Evaluation of Health Technologies and Medical PracticesUniversité LilleLilleFrance
| | - Julien Labreuche
- EA 2694, METRICS, Evaluation of Health Technologies and Medical PracticesUniversité LilleLilleFrance
| | - François Cassim
- Neuro‐sciences Unit, Clinical Neuro‐physiologyCentre Hospitalier Universitaire de Lille, Université LilleLilleFrance
| | - Max Gonzales
- Anesthesia‐Resuscitation UnitCentre Hospitalier Universitaire de Lille, Université LilleLilleFrance
| | - Charles Garabedian
- Women and Newborn Mother UnitCentre Hospitalier Universitaire de Lille, Université LilleLilleFrance
- EA 2694, METRICS, Evaluation of Health Technologies and Medical PracticesUniversité LilleLilleFrance
| | - Damien Subtil
- Women and Newborn Mother UnitCentre Hospitalier Universitaire de Lille, Université LilleLilleFrance
- EA 2694, METRICS, Evaluation of Health Technologies and Medical PracticesUniversité LilleLilleFrance
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Trager RJ, Prosak SE, Getty PJ, Barger RL, Saab ST, Dusek JA. Ischial osteochondroma as an unusual source of pregnancy-related sciatic pain: a case report. Chiropr Man Therap 2022; 30:45. [PMID: 36253863 PMCID: PMC9575271 DOI: 10.1186/s12998-022-00451-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 09/07/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While most cases of sciatica result from degenerative conditions of the low back, some cases result from conditions of the hip and pelvic region. Sciatica developing in relation to pregnancy or labor also presents unique considerations. CASE PRESENTATION A 37-year-old African American woman with a history of hypertension and polycystic ovary syndrome presented to a chiropractor at a hospital-based outpatient clinic with a seven-week history of low back pain with radiation into the right lower extremity which began during labor. The chiropractor performed a brief trial of care, yet when the patient's symptoms worsened, ordered lumbar spine radiographs, followed by lumbar magnetic resonance imaging (MRI), which were both normal. The chiropractor then ordered hip radiographs, which were suggestive of ischial osteochondroma, and referred the patient to an orthopedic oncologist. MRI findings were compatible with an osteochondroma with associated adventitial bursitis and mass effect on the sciatic nerve. The patient initially chose conservative management with bursa aspiration and therapeutic injection. Despite initial relief, there was eventual return of symptoms. The patient elected to undergo surgical removal, with a positive outcome. CONCLUSION The key distinguishing features that led to a diagnosis of osteochondroma in this case included attention to the patient-reported symptoms and history, worsening of symptoms despite conservative care, and lack of explanatory findings on lumbar imaging. This case highlights the benefit of evaluating the hip and pelvis when the clinical features of sciatica cannot be ascribed to a lumbar etiology. This case also illustrates the role of a chiropractor working in an integrative health system to facilitate timely imaging and referrals to resolve a challenging diagnosis.
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Affiliation(s)
- Robert J. Trager
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Sarah E. Prosak
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Patrick J. Getty
- grid.443867.a0000 0000 9149 4843Musculoskeletal Surgical Oncology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Orthopaedic Surgery, Case Western Reserve University, 44106 Cleveland, OH USA
| | - Richard L. Barger
- grid.443867.a0000 0000 9149 4843Division of Musculoskeletal Radiology, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA
| | - Shahrazad T. Saab
- grid.67105.350000 0001 2164 3847Department of Pathology, Case Western Reserve University School of Medicine, 44106 Cleveland, OH USA
| | - Jeffery A. Dusek
- grid.443867.a0000 0000 9149 4843Connor Whole Health, University Hospitals Cleveland Medical Center, 44106 Cleveland, OH USA ,grid.67105.350000 0001 2164 3847Department of Family Medicine and Community Health, School of Medicine, Case Western Reserve University, 44106 Cleveland, OH USA
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Wang Q, Wei S, Li S, Yu J, Zhang G, Ni C, Sun L, Zheng H. Comparison of the analgesic effect of ultrasound-guided paravertebral block and ultrasound-guided retrolaminar block in Uniportal video-assisted Thoracoscopic surgery: a prospective, randomized study. BMC Cancer 2021; 21:1229. [PMID: 34784889 PMCID: PMC8594110 DOI: 10.1186/s12885-021-08938-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/27/2021] [Indexed: 12/11/2022] Open
Abstract
Background The optimal modality for postoperative analgesia after uniportal video-assisted thoracoscopic surgery (UVATS) for the treatment of lung cancer has not yet been determined. Both ultrasound-guided paravertebral block (PVB) and retrolaminar block (RLB) have been reported to be successful in providing analgesia after UVATS. However, which block technique provides superior analgesia after UVATS is still unclear. This randomized study was designed to compare the postoperative analgesic effects and adverse events associated with ultrasound-guided PVB and RLB after UVATS. Methods Sixty patients with lung cancer were randomized to undergo ultrasound-guided PVB (group P) or ultrasound-guided RLB (group R). In group P, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided PVB (15 mL at each level on the operative side). In group R, 30 mL of 0.5% ropivacaine was injected at the T3 and T5 levels via ultrasound-guided RLB (15 mL at each level on the operative side). The primary outcome was the numerical rating scale (NRS) score within 48 h after surgery. The secondary outcomes were total postoperative sufentanil consumption, time to first analgesic request and adverse events. Results At 3, 6, 12, 24, 36 and 48 h postoperatively, the NRS score at rest in group P was lower than that in group R (p < 0.05). At 3, 6, 12, 24 and 36 h postoperatively, the NRS score while coughing in group P was lower than that in group R (p < 0.05). The total postoperative sufentanil consumption in group P was significantly lower than that in group R (p < 0.001). Additionally, the time to first analgesic request was longer in group R than in group P (p < 0.0001). The incidence of nausea in group R was higher than that in group P (p < 0.05). Conclusions In patients with lung cancer undergoing UVATS, ultrasound-guided PVB with 0.5% ropivacaine provides better analgesia and results in less nausea than ultrasound-guided RLB. Compared with ultrasound-guided RLB, ultrasound-guided PVB seems to be a better technique for analgesia in UVATS. Trial registration The name of this study is the Effect And Mechanism Of Ultrasound-guided Multimodal Regional Nerve Block On Acute And Chronic Pain After Thoracic Surgery. This study was registered in the Chinese Clinical Trial Registry (ChiCTR2100044060). The date of registration was March 9, 2021.
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Affiliation(s)
- Qiang Wang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Shijing Wei
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Shuai Li
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Jie Yu
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Guohua Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China
| | - Li Sun
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
| | - Hui Zheng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
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Bouille L, Sichitiu J, Favre J, Desseauve D. Assessing feasibility and maternal acceptability of a biomechanically-optimized supine birth position: A pilot study. PLoS One 2021; 16:e0257285. [PMID: 34506580 PMCID: PMC8432866 DOI: 10.1371/journal.pone.0257285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/30/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In order to manage a protracted second stage of labor, "eminence-based" birth positions have been suggested by some healthcare professionals. Recent biomechanical studies have promoted the use of an optimized supine birthing position in this setting. However, uncertainty exists regarding the feasibility of this posture, and its acceptability by women. This pilot study primarily aimed to assess these characteristics. OBJECTIVE AND METHODS In this monocentric prospective study, 20 women with a protracted second stage of labor were asked to maintain a biomechanically-optimized position for at least 20 minutes at full dilatation. This posture is similar to the McRoberts' maneuver. Maintaining the position for 20 minutes or more was considered clinically relevant and indicative of feasibility and acceptability. Satisfaction with the position was assessed using a Visual Analogue Scale (VAS). A sub-group analysis was performed to assess eventual differences between more and less satisfied patients, according to the median of patients' satisfaction scores. RESULTS Seventeen patients (85%) maintained the optimized position for at least 20 minutes. The median satisfaction score of these participants was 8 (interquartile range: 1) out of 10. No significant differences were found between the two sub-groups (satisfaction score <8 vs satisfaction score ≥8) regarding general and obstetric characteristics, as well as obstetrical and fetal outcomes. CONCLUSION The optimized position is acceptable and feasible for women experiencing a protracted second stage of labor. Further clinical studies are needed to assess the efficiency of such positions when women undergo an obstructed labor.
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Affiliation(s)
- Lisa Bouille
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Joanna Sichitiu
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
| | - Julien Favre
- Department of Musculoskeletal Medicine, Swiss BioMotion Lab, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), Lausanne, Vaud, Switzerland
| | - David Desseauve
- Women-Mother-Child Department, Lausanne University Hospital, Lausanne, Vaud, Switzerland
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Rider Sleutel M, True B, Webb J, Valdez E, Van Thi Tran M. Integrative Review of Lower Extremity Nerve Injury During Vaginal Birth. J Obstet Gynecol Neonatal Nurs 2020; 49:507-524. [PMID: 33096043 DOI: 10.1016/j.jogn.2020.09.155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the incidence, health effects, risk factors, and practice implications of lower extremity nerve injury (LENI) related to vaginal births. DATA SOURCES We searched MEDLINE, CINAHL, and PubMed from 2000 to 2020 for peer-reviewed published case reports and research studies of LENI related to vaginal births. STUDY SELECTION We identified 188 potential records, and 20 met inclusion criteria (six research studies and 14 case studies). DATA EXTRACTION Three independent reviewers extracted details of injuries and births into an Excel spreadsheet and analyzed data using SPSS. DATA SYNTHESIS Using birth data from each case study and from four of the six research articles, we found the incidence of LENI in vaginal births was 0.3% to 1.8%. The description of health effects includes affected nerves and the location, description, and duration of symptoms. Analyses of risk factors were limited by missing birth data (length of second stage, birth weight, etc). Vaginal births with LENI were 76% spontaneous, 77% with neuraxial anesthesia, and 64% first vaginal birth. Practice implications focused on prevention through specific positioning strategies. Despite nurses being the primary caregivers during labor, LENI was reported most often in anesthesia journals with virtually no reports in nursing journals. CONCLUSION LENI is a potential complication of vaginal birth, and little published research is available on prevention and prognosis. While obstetric and anesthesia factors can cause or contribute to nerve injury, LENI is usually caused by positioning and is considered preventable. Care recommendations include the following: avoid prolonged hyperflexion of women's thighs and knees; minimize time in lithotomy, squatting, or kneeling positions; prevent hand or other deep pressure on lateral knee and posterior thigh areas; avoid motor-blocking neuraxial (epidural) anesthesia; and implement frequent repositioning. The paucity of literature contributes to the lack of awareness of LENI among clinicians.
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Lower Extremity Nerve Injury in Childbirth: AWHONN Practice Brief Number 11. J Obstet Gynecol Neonatal Nurs 2020; 49:622-624. [PMID: 33092945 DOI: 10.1016/j.jogn.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Lower Extremity Nerve Injury in Childbirth: AWHONN Practice Brief Number 11. Nurs Womens Health 2020; 24:470-472. [PMID: 33093000 DOI: 10.1016/j.nwh.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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On Analgesia and Anesthesia in the Intrapartum Period: Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2020; 49:227-229. [DOI: 10.1016/j.jogn.2020.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2020] [Indexed: 12/22/2022] Open
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15
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Lower-limb neurologic deficit after vaginal delivery: a prospective observational study. Int J Obstet Anesth 2020; 41:35-38. [DOI: 10.1016/j.ijoa.2019.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 08/12/2019] [Accepted: 09/12/2019] [Indexed: 11/18/2022]
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Brück S, Annecke T, Bremerich D, Byhahn C, Chappell D, Kaufner L, Schlösser L, Kranke P. „Hot topics“ aus der geburtshilflichen Anästhesie. Anaesthesist 2020; 69:11-19. [DOI: 10.1007/s00101-019-00718-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
PURPOSE OF REVIEW Central neuraxial blockade is increasingly the anaesthetic management of choice for parturients, including in higher risk pregnancies. Although they are usually effective and safe, there are potentially devastating neurological complications that may present either overtly or insidiously. A thorough understanding of the variety of potential neurological complications is essential to adequately consent patients in addition to diagnosing and managing complications following neuraxial anaesthesia. This review aims to describe a number of potential neurological injuries that may occur and suggested management based on available evidence. RECENT FINDINGS Current evidence supports neuraxial anaesthesia as a safe management strategy in low and many higher risk pregnancies, with a low overall incidence of neurological complications. Neuraxial blockade is safe in patients with platelet counts greater than 70 000/μl and the risk of infective complications secondary to epidural catheterization remains low until day five post procedure. There is also some early evidence supporting the use of transnasal local anaesthetic as a strategy for managing postdural puncture headache. SUMMARY Difficulty remains in establishing absolute risk of complications and optimal management strategies given the low overall number of patients affected and heterogeneity of therapy. There may be a role for centralized registration of postneuraxial complications in obstetric patients to further develop our collective understanding of these conditions.
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Shih CK. Immediate bilateral peroneal nerve palsy in a healthy null parturient after elective cesarean section. Asian J Anesthesiol 2017; 55:45. [PMID: 28971805 DOI: 10.1016/j.aja.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/09/2017] [Accepted: 05/02/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Chih-Kai Shih
- Department of Anesthesiology, Changhua Christian Hospital, 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan, ROC.
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Haller G, Pichon I, Gay FO, Savoldelli G. Risk factors for peripheral nerve injuries following neuraxial labour analgesia: a nested case-control study. Acta Anaesthesiol Scand 2017; 61:1203-1214. [PMID: 28766691 DOI: 10.1111/aas.12951] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 12/23/2016] [Accepted: 07/10/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-partum lower extremity motor and sensory dysfunctions occur in 0.1-9.2‰ of deliveries. While macrosomia, lithotomy position and forceps use are well-identified causes of peripheral nerve injuries, additional contributors such as patient condition and anaesthesia care may also have to be considered. METHODS We performed a case-control study nested in a cohort of 19,840 patients having neuraxial anaesthesia for childbirth. Cases were all patients who developed motor or sensory dysfunction of lower extremities in the post-partum period. These were compared, using Chi-square, Fisher's exact test, logistic regression and time series, to a random sample of controls without any neurological symptoms or injury. RESULTS We identified 19 (0.96‰) patients with peripheral nerve injuries of which 15 (0.76‰) were likely associated with obstetrical care. In four additional cases (0.20‰), a nerve root injury due to the Tuohy needle was suspected. Univariate risk factors were: a gestational age ≥ 41 weeks, Odds Ratio (OR) 3.8; 95% CI: 1.1-13.1, late initiation of neuraxial anaesthesia OR 8.2; 95% CI: 1.8-37.9, a repeated anaesthetic procedure OR 2.8; 95% CI: 1.0-7.8, assisted delivery with forceps OR 9.8; 95% CI: 1.2-114.1 and newborn birth weight > 3.5 kg with an OR 6.8; 95% CI: 2.0-22.5. CONCLUSION Obstetrical related factors are the most prominent risk associated with peripheral nerve injuries. This study highlights however that patient and anaesthesia-related factors may also contribute to peripheral nerve injuries.
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Affiliation(s)
- G. Haller
- Division of Anaesthesia; Department of Anaesthesiology, Pharmacology and Intensive Care; Geneva University Hospitals; Geneva Switzerland
- Department of Epidemiology & Preventive Medicine; Health Services Management and Research Unit; The Alfred Centre; Monash University; Melbourne Vic. Australia
| | - I. Pichon
- Division of Anaesthesia; Department of Anaesthesiology, Pharmacology and Intensive Care; Geneva University Hospitals; Geneva Switzerland
| | - F.-O. Gay
- Unit of Anaesthesia; Clinique de Valère; Sion Switzerland
| | - G. Savoldelli
- Division of Anaesthesia; Department of Anaesthesiology, Pharmacology and Intensive Care; Geneva University Hospitals; Geneva Switzerland
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Good prognosis of postpartum lower limb sensorimotor deficit: a combined clinical, electrophysiological, and radiological follow-up. J Neurol 2017; 264:529-540. [DOI: 10.1007/s00415-016-8388-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 11/26/2022]
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Desseauve D, Fradet L, Lacouture P, Pierre F. Position for labor and birth: State of knowledge and biomechanical perspectives. Eur J Obstet Gynecol Reprod Biol 2017; 208:46-54. [DOI: 10.1016/j.ejogrb.2016.11.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 11/10/2016] [Indexed: 11/27/2022]
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Desseauve D, Gachon B, Bertherat P, Fradet L, Lacouture P, Pierre F. [In which position do women give birth in 2015? Results from a prospective multicenter study]. ACTA ACUST UNITED AC 2016; 44:548-556. [PMID: 27450381 DOI: 10.1016/j.gyobfe.2016.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 06/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess the frequency of labor and birth positions in 2015, and identify factors associated with choosing and changing position during labor. METHODS Multicenter prospective study during five weeks in 2015. We collected the distribution of the observed positions during the first and second stage of labor. Then we considered the main birth position as the one used for the longest duration. Factors associated to the main birth position as well as to the changes of position during labor were studied using univariate analysis and the role of each factor was analyzed using multilevel logistic regression. RESULTS Among women who delivered, 86.1% did so in gynecological position. There was a center effect for the position during the expulsive phase, which was not related to legal status or level of perinatal care. After adjustment, a labor duration shorter than 2hours was associated to dorsal decubitus during labor (OR=2.1 95%CI [1.01-4.3]). Prematurity and labor duration less than 2hours decreased the occurrence of changes in position during labor: OR=0.05 95%CI [0.01-0.2] and OR=0.2 95%CI [0.1-0.3]. Epidural analgesia was associated to change in birth position during labor: (OR=2.1 95%CI [1.2-3.8]). During the expulsive phase, primiparity and labor duration less than 2hours were associated to dorsal decubitus position (OR=3.6 95%CI [1.2-10.8]). CONCLUSION Women still mostly deliver in gynecological position in 2015. A systematic collection of birth positions on the partograph, with an acute definition of these positions, could allow an evaluation of the benefits/disadvantages of the different positions currently available.
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Affiliation(s)
- D Desseauve
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France; Institut Prime UPR 3346-CNRS, Axe RoBioSS, université de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France.
| | - B Gachon
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France; Institut Prime UPR 3346-CNRS, Axe RoBioSS, université de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - P Bertherat
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - L Fradet
- Institut Prime UPR 3346-CNRS, Axe RoBioSS, université de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - P Lacouture
- Institut Prime UPR 3346-CNRS, Axe RoBioSS, université de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
| | - F Pierre
- Service de gynécologie-obstétrique et médecine de la reproduction, centre hospitalier universitaire de Poitiers, 2, rue de la Milétrie, BP 577, 86021 Poitiers, France
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Hakeem R, Neppe C. Intrinsic Obstetric Palsy: Case Report and Literature Review. J Clin Diagn Res 2016; 10:QD06-7. [PMID: 27190901 DOI: 10.7860/jcdr/2016/18797.7693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/23/2016] [Indexed: 11/24/2022]
Abstract
Maternal neurological injuries may be intrinsic to the labour and delivery process or may result directly or indirectly from obstetric or anaesthetic intervention. This intrinsic obstetric palsy is a rare complication of labour but can have devastating impact on a previously healthy mother. A 23-year-old gravida1, para0 who had epidural for labour analgesia, was augmented for slow progress and had a normal vaginal delivery. She was diagnosed post delivery with intrinsic obstetric palsy involving several peripheral nerves and lumbosacral nerve roots with a guarded prognosis. In this article we have discussed the risk factors and mechanisms of intrinsic obstetric palsy and proposed further investigation into the potential protective role of ambulatory analgesia i.e. CSE (Combined Spinal Epidural) or LDI (Low Dose Infusion).
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Affiliation(s)
- Rashida Hakeem
- CMO, Department of Obstetrics & Gynaecology, Joondalup Health Campus , Joondalup WA Australia
| | - Cliff Neppe
- Director, Department of Obstetrics & Gynaecology, Joondalup Health Campus , Joondalup WA Australia
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Persistent cauda equina syndrome after cesarean section under combined spinal-epidural anesthesia: a case report. J Clin Anesth 2015; 27:520-3. [DOI: 10.1016/j.jclinane.2015.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 04/06/2015] [Accepted: 05/21/2015] [Indexed: 11/21/2022]
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Abstract
STUDY DESIGN Resident's case problem. BACKGROUND Groin pain represents a diagnostic challenge and requires a diagnostic process that rules out life-threatening illness or disease processes. Osteomyelitis is a potential fatal disease process that requires accurate diagnosis and medical management. Osteomyelitis presents a problem for the outpatient physical therapist, as the described physical findings for the diagnosis of osteomyelitis are nonspecific. DIAGNOSIS A 67-year-old man with groin and bilateral medial thigh pain was referred for physical therapy care to address right adductor weakness and generalized deconditioning. He had undergone extensive treatment for bladder cancer, with a recent radical cystoprostatectomy and cutaneous urinary diversion with an Indiana pouch. Postsurgical magnetic resonance imaging indicated normal findings, and the patient was currently being managed by an orthopaedic surgeon, who diagnosed the patient as having obturator nerve palsy. The physical therapist's examination produced findings inconsistent with this diagnosis. Subsequently, nuclear medicine studies revealed pubic symphysitis/osteomyelitis with secondary myositis, predominantly affecting the right adductor muscles. DISCUSSION Osteomyelitis represents a difficult problem for the outpatient physical therapist. Careful consideration of red-flag symptoms and inconclusive physical testing indicate the need for further medical work-up. In this case, appropriate medical management led to improvement in patient function, highlighting the need for early diagnosis. LEVEL OF EVIDENCE Differential diagnosis, level 4.
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Zaphiratos V, McKeen DM, Macaulay B, George RB. Persistent paralysis after spinal anesthesia for cesarean delivery. J Clin Anesth 2014; 27:68-72. [PMID: 25433726 DOI: 10.1016/j.jclinane.2014.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/14/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
Anterior spinal artery syndrome has rarely been reported as a cause of permanent neurologic complications after neuraxial anesthesia in obstetric patients. A parturient developed anterior spinal artery syndrome after spinal anesthesia for cesarean delivery. A healthy 32-year-old parturient presented at 41(2/7) weeks for primary elective caesarean delivery for breech presentation. Spinal anesthesia was easily performed with clear cerebrospinal fluid, and block height was T4 at 5 minutes. Intraoperative course was uneventful except for symptomatic bradycardia (37-40 beats per minute) and hypotension (88/44 mm Hg) 4 minutes postspinal anesthesia, treated with ephedrine and atropine. Dense motor block persisted 9 hours after spinal anesthesia, and magnetic resonance imaging of the lumbosacral region was normal, finding no spinal cord compression or lesion. Physical examination revealed deficits consistent with a spinal cord lesion at T6, impacting the anterior spinal cord while sparing the posterior tracts.
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Affiliation(s)
| | | | - Bruce Macaulay
- IWK Health Centre, Dalhousie University, Halifax, NS, Canada
| | - Ronald B George
- IWK Health Centre, Dalhousie University, Halifax, NS, Canada
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Saignement péridural suite à une analgésie péridurale obstétricale. ACTA ACUST UNITED AC 2014; 33:690-2. [DOI: 10.1016/j.annfar.2014.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 10/20/2014] [Indexed: 11/18/2022]
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An Uncommon Case of Bilateral Peroneal Nerve Palsy following Delivery: A Case Report and Review of the Literature. Case Rep Obstet Gynecol 2014; 2014:746480. [PMID: 25180116 PMCID: PMC4142536 DOI: 10.1155/2014/746480] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
Peroneal nerve palsy is an infrequent but potential complication of childbirth. Bilateral peroneal palsy is particularly rare following delivery with few reported cases. A 38-year-old gravida 1, para 0 underwent a prolonged second stage of labor, was diagnosed with an arrest of descent, and subsequently underwent an uncomplicated primary cesarean section. The patient was diagnosed with bilateral peroneal neuropathy four days after delivery. By two months postpartum, her foot drop had improved by 85% and the remainder of her symptoms resolved. Awareness of the risks of a peroneal neuropathy as well as implementation of preventive measures is important for members of the delivery team. Regional anesthesia during labor is a risk factor for the development of a peroneal neuropathy.
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KANG XH, BAO FP, XIONG XX, LI M, JIN TT, SHAO J, ZHU SM. Major complications of epidural anesthesia: a prospective study of 5083 cases at a single hospital. Acta Anaesthesiol Scand 2014; 58:858-66. [PMID: 24961586 DOI: 10.1111/aas.12360] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND We undertook a prospective study of non-obstetric epidurals placed in surgical inpatients at a single teaching hospital to evaluate the incidence of and potential risk factors for major complications of continuous epidural anesthesia. METHODS Demographic information, details of the epidural procedure, and complications (from the pre-anesthetic period through resolution) were recorded for more than 5000 surgical inpatients who underwent continuous epidural anesthesia in our institution between March 2009 and April 2011. The incidence of and risk factors for major complications were evaluated. RESULTS During the study period, 5083 patients were interviewed and their details were recorded (98% capture rate). Sixty-nine (1.36%) experienced major complications: epidural hematoma in 1 patient (0.02%), post-operative neurologic deficits in 57 patients (1.12%), post-dural puncture headache in 7 patients (0.14%), and systemic local anesthetic toxicity in 4 patients (0.08%). Only one patient had permanent sequelae: unilateral lower limb paresthesia. Identified risk factors for neurologic deficits were as follows: American Society of Anesthesiologists status II-III, siting in the lumbar region, orthopedic and urologic surgery, multiple attempts to site an epidural, paresthesia during insertion, a history of neuraxial anesthesia, and use of patient-controlled epidural analgesia. CONCLUSIONS Serious complications were very rare; only one patient had permanent sequelae, and a single epidural hematoma was diagnosed. Post-operative neurologic deficits were more common, but most complications resolved spontaneously within 3 months and they rarely required intervention.
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Affiliation(s)
- X.-H. KANG
- Department of Anesthesiology; the First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - F.-P. BAO
- Department of Anesthesiology; the First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - X.-X. XIONG
- Department of Anesthesiology; the First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - M. LI
- Department of Anesthesiology; the First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - T.-T. JIN
- Department of Anesthesiology; the First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
| | - J. SHAO
- Department of Statistics; University of Wisconsin - Madison; Madison WI USA
| | - S.-M. ZHU
- Department of Anesthesiology; the First Affiliated Hospital; School of Medicine; Zhejiang University; Hangzhou China
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Neurologic Complications After Chlorhexidine Antisepsis for Spinal Anesthesia. Reg Anesth Pain Med 2012; 37:139-44. [DOI: 10.1097/aap.0b013e318244179a] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Acute neurological diseases requiring hospitalization are relatively rare in women of childbearing age. However, during pregnancy and the postpartum period, several diseases increase in prevalence. Some are unique to the pregnant/postpartum state including preeclampsia and delivery-associated neuropathies. Others, although indirectly related to pregnancy, such as cerebral venous thrombosis, ischemic stroke, and intracerebral hemorrhage, increase in frequency and carry considerable risk of morbidity and mortality. In addition, treatment options are often limited. This review discusses the diseases more commonly seen during pregnancy and the postpartum period, with a focus on emergent neurological diseases and their management. Interventional therapies will also be discussed.
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Affiliation(s)
| | - Louise D. McCullough
- Hartford Hospital Stroke Center, Hartford CT, USA
- The University of Connecticut Health Center, Farmington, CT, USA
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Quality of life following permanent neurological damage after subarachnoid block. Case Rep Anesthesiol 2011; 2011:906905. [PMID: 22606399 PMCID: PMC3350023 DOI: 10.1155/2011/906905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/02/2011] [Indexed: 11/18/2022] Open
Abstract
Introduction. Caesarean section is the commonest operation carried out in females of the reproductive age group. Spinal anaesthesia is commonly used for caesarean section with its risk. Permanent paralysis of the lower limbs following subarachnoid block is a rare complication but can occur even in the best of hands. Case Summary. This is a 29-year-old final-year university student now 34 years old who had emergency caesarean section for cephalopelvic disproportion in 2005 under spinal anaesthesia in a low-resource setting in a developing country. She developed permanent neurological deficit thereafter. She had urinary and faecal incontinence for one year. She lost one academic session at her school because of long hospital stay and is now confined to a wheel chair. She celebrated her daughter's fifth birthday in October, 2010. Although there is ability in inability, she is now disabled. Conclusion. It is important for clinicians to recognise the complications of subarachnoid block promptly to avoid delay in treatment and severe neurological deficits.
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Al-Ajmi A, Rousseff RT, Khuraibet AJ. Iatrogenic femoral neuropathy: two cases and literature update. J Clin Neuromuscul Dis 2010; 12:66-75. [PMID: 21386773 DOI: 10.1097/cnd.0b013e3181f3dbe7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Iatrogenic femoral neuropathy is an uncommon surgical or obstetric complication that may be underreported. It results from compression, stretch, ischemia, or direct trauma of the nerve during hip arthroplasty, self-retaining retractor use in pelvicoabdominal surgery, lithotomy positioning for anesthesia or labor, and other more rare causes. Decreasing incidence of this complication after abdominal and gynecologic surgery but increase in its absolute numbers after hip arthroplasty has emerged over the last decade. We describe two illustrative cases related respectively to lithotomy positioning and self-retaining retractor use. The variability in clinical presentation of iatrogenic femoral nerve lesions, some new insights in their diverse pathophysiology, and in the diagnostic and treatment options are discussed with an update from the literature.
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