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Intraoperative positioning during cesarean as a cause of sciatic neuropathy
Sarmistha Roy1, Amy B Levine, Gerald J Herbison
1Department of Rehabilitation Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. sarmisthar@yahoo.com
Background:
Sciatic nerve compression has been well documented as a cause of perioperative sciatic neuropathy but rarely during cesarean.
Case:
A parturient complained of left foot drop after cesarean delivery for twins performed under spinal anesthesia. Intraoperatively, her right hip was raised with padding under the right buttock to tilt the pelvis approximately 30 degrees to the left. Postoperatively, the patient had weakness, sensory changes, and diminished reflexes in the left lower extremity. Electrodiagnostic studies supported a diagnosis of neurapraxia and partial denervation in the distribution of the sciatic nerve. By postpartum week 6, she had full recovery.
Conclusion:
Elevating the right buttock during cesarean can cause compression of the underlying structures of the left buttock and result in sciatic neuropathy. Decreasing the duration of time the patient is in the left lateral position may reduce the risk of this uncommon but debilitating complication.