Hyperbaric oxygen therapy in peroneal nerve damage due to lithotomy position

Abstract

Peripheral neuropathies can be seen in patients who are operated in lithotomy position. In this case report, patient which had right drop foot after urethroplasty surgery in lithotomy position was treated. Electromyography (EMG) was performed at postoperative 1st day and demonstrated right peroneal nerve palsy. Physiotherapy (knee extension, cycling, and passive dorsiflexion), vitamin B complex (B1, B6, folic acid and B12) and daily hyperbaric oxygen treatment were started. Fifth day after surgery, improvement of moving the right foot was detected clinically. Patient was discharged on 7th postoperative day and neurologist suggested to continue physiotherapy and vitamin B complex for 3 weeks. After this period, control EMG showed the development of peroneal nerve functions. The patient had a fully functional right foot with all these treatments one month after surgery. Effectivity of hyperbaric oxygen in treatment of peripheral nerve degeneration was seen in several studies in literature (4). In a few studies, the effect of hyperbaric oxygen on peroneal nerve palsy has not been demonstrated (5). The patient recovered earlier than other patients in literature. In this case, the treatment difference was hyperbaric oxygen treatment from other cases in literature. Before the start of lithotomy operations, patients should be carefully evaluated for peroneal nerve palsy risk factors and appropriately positioned to prevent iatrogenic peroneal nerve palsy in the operation. After operation, if peroneal nerve palsy develops, physiotherapy should start as soon as possible. Hyperbaric oxygen is kept in mind as supplemental treatment even if it is not in standard treatment protocol in peroneal nerve palsy.