Drop Following Hernia Surgery

50 y/o female admitted for abdominal surgery for excision of abd wall hernia following uterine malignancy. The operative procedure lasted more than 9 hours with the majority of the procedure in extreme Trendelenburg position. Patient complained of leg pain immediately on arrival to PACU. The discharge note makes no mention of any complaints. Patient returned to the hospital on complaining of fever. The triage note states “right foot drop”.Two months post-op, patient was examined and the Dr found that she had a significant right foot drop that was “likely right peroneal neuropathy secondary to transient nerve injury during an operation.

MEDQUEST EXPERT RESPONSES:

Yes this is probably a positioning injury the mechanics of which need to be detailed by reviewing all the pertinent notes in the OR record. The surgeon, anesthesiologist and nurses share responsibility for correctly placing the patient in a safe position. That being said, each team generally looks after different body parts and it is customary for the surgeon to position the legs although I have no direct evidence for what happened here. It could also potentially be from a misapplied leg restraint strap. Dr MD – Anesthesia

Positioning is a joint respomsibility of the surgical, nursing, and anesthesia care teams. If there was no pre-exisitng conditions that might pre-dispose this patient to develop nerve problems post- op there might be a case here. Dr AW – Anesthesia