Nerve injuries associated with gynaecological surgery

Abstract

Key content Nerve injuries are a common complication of gynaecological surgery, occurring in 1.1–1.9% of cases. Patient mal‐positioning, incorrect placement of self‐retaining retractors, haematoma formation and direct nerve entrapment or transection are the primary causative factors in perioperative nerve injury. Nerves most commonly injured during surgery include the femoral, ilioinguinal, pudendal, obturator, lateral cutaneous, iliohypogastric and genitofemoral nerves. The majority of neuropathies resolve with conservative management and physiotherapy. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and gamma‐aminobutyric acid (GABA) antagonists are of significant benefit in managing painful neuropathies. Learning objectives To gain an overview of the spectrum of different neuropathies that may occur following pelvic surgery. To learn about safe surgical techniques in the prevention of postoperative neuropathies. To review the clinical anatomy of the lumbo‐sacral and brachial plexuses. Ethical issues Neuropathies can cause considerable postoperative morbidity. Should neuropathies following gynaecology surgery be discussed routinely during consent taking? Neuropathies following surgery may have considerable medico‐legal implications.