Most commonly injured lower extremity nerve in patients undergoing surgery in lithotomy position was the common peroneal nerve(L4-S2, represented 78% of nerve injuries in a study which looked retrospectively at 198,461 patients undergoing surgery in the lithotomy position).
Etiology: Is thought to be secondary to compression of the nerve between the lateral head of the fibula and the bar holding the legs. When the candy cane stirrups are used, special attention must be paid to avoid compression.
Associated factors: patients with a low body mass index, recent cigarette smoking, prolonged duration of surgery
A prospective review of 991 patients undergoing surgery in the lithotomy position from 1997 to 1998, showed that there were no motor neuropathies in the lower extremity, although paresthesias in the distribution of the obturator, lateral femoral cutaneous, sciatic, and peroneal nerves were found.
Nerve Injuries in Lithotomy Position
- Most Commmon: common peroneal (78%)
- Etiology: compression
- Risk Factors: low BMI, smoking, prolonged surgery
- Manifestation: common peroneal is L4-S2, responsible for foot dorsiflextion and toe extension (thus leads to foot drop)
M A Warner, J T Martin, D R Schroeder, K P Offord, C G Chute Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position. Anesthesiology: 1994, 81(1);6-12
M A Warner, D O Warner, C M Harper, D R Schroeder, P M Maxson Lower extremity neuropathies associated with lithotomy positions. Anesthesiology: 2000, 93(4);938-42