Femoral Neuropathy after Appendectomy

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  • NISHIKIDO Osamu
    Department of Anesthesiology, St Marianna University School of Medicine
  • TATEDA Takeshi
    Department of Anesthesiology, St Marianna University School of Medicine
  • OKAMOTO Yasuaki
    Department of Anesthesiology, St Marianna University School of Medicine
  • MIYAZAWA Shouko
    Department of Anesthesiology, St Marianna University School of Medicine
  • YAMANAKA Ikuo
    Department of Anesthesiology, St Marianna University School of Medicine

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  • 虫垂切除術後に右大腿神経麻痺をきたした1例
  • ショウレイ チュウスイ セツジョ ジュツゴ ニ ミギ ダイタイ シンケイ マヒ オ キタシタ 1レイ

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Abstract

A 41-year-old woman underwent appendectomy under spinal anesthesia. A 22 G spinal needle was inserted into the sub-arachnoid space through the L34 interspace, followed by the injection of 3.0ml 0.5% hyperbaric bupivacaine. The analgetic level was obtained adequately below T8 bilaterally. During spinal anesthesia, her operative course was uneventful for 2.5 hours, and then anesthesia was maintained with nitrous oxide and sevoflurane in oxygen because of prolongation of the surgical procedure. On the first postoperative day, the patient complained of dysesthesia of the anterior aspects of the right thigh and leg, and walking disturbance. Magnetic resonance imaging (MRI) findings were normal. Neurological examination and electromyogram (EMG) revealed right femoral neuropathy, and the complication was determined to be due to the retractor compression during surgery. The administration of vitamin B12, steroid, prostaglandin E1 and epidural blockage improved dysesthesia, sensory loss and motor weakness. After 1.5 months, the patient completely recovered from the neurological symptoms. This case emphasizes the importance of excluding neurological complications encountered with spinal anesthesia.

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