[Peroneal nerve palsy after total knee arthroplasty under continuous epidural anaesthesia].

Der Orthopäde
J BellerM Lukoschek

Abstract

Peroneal nerve palsy is a rare but distressing complication of total knee arthroplasty (TKA). After introducing a standardised intraoperative and postoperative epidural anaesthesia protocol under otherwise unchanged perioperative management, we noted a sudden cumulation of peroneal nerve palsies after TKA. In this retrospective study we checked the patients' histories for well-known risk factors for nerve lesions after TKA as well as for those risk factors controversially discussed in the literature. We found an additive harmful impact of epidural anaesthesia leading to unrecognised pressure on the peroneal nerve, which caused, in combination with a pressure lesion of the pneumatic tourniquet, an axonal lesion in terms of a double-crush syndrome. By lowering the pneumatic tourniquet pressure and carefully positioning the operated leg, we found a clearly reduced risk of nerve lesion while preserving the advantages of epidural anaesthesia for the patient. To prevent a peroneal lesion after TKA while using continuous epidural anaesthesia, we strongly recommend limiting the pneumatic tourniquet pressure to 320 mmHg while ensuring pressure-free positioning of the operated leg.

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Citations

Jul 21, 2015·Regional Anesthesia and Pain Medicine·Tim DwyerRichard Brull
Jul 21, 2015·Regional Anesthesia and Pain Medicine·Andrea VeljkovicRichard Brull
Apr 26, 2019·Chemical Record : an Official Publication of the Chemical Society of Japan ... [et Al.]·Vaishali S ShendeBhalchandra M Bhanage
Jul 10, 2018·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Richard L KahnJacques T YaDeau
Aug 21, 2012·Clinical Orthopaedics and Related Research·Michael C LiebensteinerEckart Mayr
Feb 25, 2021·Orthopaedic Surgery·Ke ShenXiaofeng Wang
Jul 23, 2021·Orthopedics·David B JohnsonAdolph V Lombardi
Jun 24, 2010·The Journal of Arthroplasty·Michael G ZywielAnil Bhave

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