[Rhabdomyolysis after nephrectomy in the lateral flexed decubitus position]

We report two cases of the rhabdomyolysis of the erector spine muscles occurring after nephrectomy in lateral flexed decubitus position. Case 1. A 39-year-old man (170-cm, 85-kg) underwent right nephrectomy for a right renal tumor. The patient was placed in a left flexed lateral decubitus position with a roll placed under the dependent iliac crest and upper half of the body was rotated backward for 6 h. The patient complained of severe left low back pain after the operation. On postoperative day 2, serum creatinine increased to 28,480 U.l-1 (MM 99%). Computed tomography scanning performed on postoperative day 4 showed hypodensity of the left erector spine muscles. Although the patient complained of severe pain, no other critical complications including renal failure occurred during the postoperative period. Case 2. A 59-year-old man (169-cm, 87-kg) was scheduled for right nephroureterectomy and partial resection of bladder for a right renal tumor. The patient was placed in a right flexed lateral decubitus position with a roll of towel and sponge placed under the dependent iliac crest for 8 hr. On postoperative day 1, CPK increased to 35,315 U.l-1 (MM 99%) and peaked at 55,760 U.l-1 (MM 99%) on postoperative day 2. Haptoglobin was administered and lactated Ringer and loop diuretics were administered. Fortunately the patient did not develop renal failure. Direct, prolonged pressure on the paravertebral muscle was the etiology of rhabdomyolysis in our cases. Although our cases were not severe and the complications were not induced, it must be kept in mind that excessive pressure in a limited area can damage the muscle during prolonged surgery.