Nerve injuries associated with gynaecological surgery

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Nerve Injuries Associated with Gynaecological Surgery Kuponiyi O et al. Nerve injuries associated with gynaecological surgery. TOG 2014;16:29–36. doi:10.1111/tog.12064

1.1–1.9% ≥11% 3.7% INCIDENCE OF NEUROPATHY POST-GYNAE FEMORAL NERVE = COMMONEST INJURED ILIOINGUINAL/ILIOHYPOGASTRIC INJURY POST- SURGERY PFANNENSTIEL

DO N' T-M IS S FA C TS

  1. Incidence of neuropathy post-gynae surgery: 1.1–1.9%; femoral nerve commonest (≥11%)

  2. Self-retaining retractors: 8% femoral neuropathy vs <1% without (Goldman et al.) – blades should cradle rectus, not compress psoas

  3. Ilioinguinal/iliohypogastric injury post-Pfannenstiel: 3.7%; diagnostic triad = radiating pain + paraesthesia + relief with LA infiltration

  4. Pudendal nerve at risk during sacrospinous ligament fixation

  5. EMG timing: 3–4 weeks post-injury (denervation is delayed)

  6. Sensory recovery ~5 days; motor recovery up to 10 weeks; may persist >1 year

  7. Erb's palsy = arm board >90° abduction (C5–C6); Klumpke's palsy = laterally-placed shoulder brace in Trendelenburg (C8– T1)

  8. NZ data: nerve damage = 4th commonest treatment injury, 4.3% of claims; mal-positioning under GA = leading cause

INJURY GRADE AT A GLANCE

Neuropraxia – compression, recovers weeks–months Axonotmesis – axon damaged, Schwann intact, months

Neurotmesis – transection, poor prognosis w/o repair

ABBREVIATION KEY

EMG — electromyography NHS — National Health Service

SSRI — selective serotonin reuptake inhibitor ASIS — anterior superior iliac spine

GABA — gamma-aminobutyric acid

Source: The Obstetrician & Gynaecologist (TOG), RCOG journal — Kuponiyi O et al. Nerve injuries associated with gynaecological surgery. TOG 2014;16:29–36. doi:10.1111/tog.12064

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