Position-Related Postoperative Peripheral Neuropathy After Laparoscopic Colorectal Surgery: A Comparative Single-Center Prospective Cohort Study

Abstract

Background: Laparoscopic colorectal surgery requires perioperative positioning in the dorsal lithotomy position and intermittent Trendelenburg position. This position is associated with postoperative peripheral neuropathy (PPN), which is a substantial cause of anesthesia-related claims. The objective of this study was to assess the incidence of PPN of patients positioned in lithotomy position with shoulder braces, and second to compare this group with patients positioned on the foam mattress Pink Pad^®. Materials and Methods: This consecutive single-center prospective cohort study of 155 patients undergoing colorectal surgery was performed between November 2014 and June 2015. After initial results the implementation of the Pink Pad took place and a total of 52 patients were included between May 2016 and February 2017 to compare the two groups. Results: Positioning with the shoulder brace regimen during laparoscopic colorectal surgery was related to the development of PPN in 33% of cases, as opposed to 15% with Pink Pad. Positioning with shoulder braces increased the risk of PPN with an odds ratio of 3.14 (95% confidence interval: 1.10-8.992) when compared with positioning on Pink Pad. Conclusion: Position-related PPN is an important complication after laparoscopic colorectal surgery. This study concludes that careful attention should be paid to positioning and favors Pink Pad over positioning with shoulder braces. Prolonged time in anesthesia is a predictor of PPN. Clinical Trial Number: H-2-2014-FSP75.

Keywords: colorectal surgery; laparoscopy; peripheral nerve injury; positioning.