Post-operative foot drop after extra fascial hysterectomy under combined epidural and general anesthesia: a case report / Asuncion, Reynaldo Raul N. [author]

Includes bibiliographical references.

BASTRACT: There are multiple causes that can result in foot drop or peripheral nerve injuries such as compression, transection, nerve ischemia, radiation-induced injury, inflammation, and degeneration. Electromyography can provide information regarding nerve supply to the muscle. Nerve conduction studies can identify the number of nerve fibers participating in the conduction of an impulse. Electrophysiology can distinguish between nerve dysfunction due to axonal degeneration such as perioperative peripheral nerve injury and nerve dysfunction due to demyelination. The timing of the electrophysiological studies is important to diagnose a perioperative peripheral nerve injury. Extra fascial hysterectomy is done by longitudinal incisions lateral to the rectus muscle, in the midline, or a transverse incision placed within the borders of the rectus muscles and 2 cm above the symphysis pubis resulting in minimal loss of neural function because the incision runs parallel to local nerves. However, dissection of the anterior rectus sheath, as required for the Pfannenstiel, may injure terminal sensory nerve fibers of the anterior cutaneous branches of the Ili hypogastric and ilioinguinal nerves and nerve perforating branches of the epigastric vessels. In our institution, extra fascial hysterectomy can be performed under neuraxial anesthesia, general anesthesia, or a combination of both. The advantage of doing combined neuraxial and general anesthesia results in the attainment of profound muscle relaxation, especially during abdominal surgeries, hemodynamic control, secured airway, and provision of superior post-operative pain control through the epidural catheter.

Research - Department of Anesthesiology