Meralgia Paraesthetica after Prone Position Ventilation in a Patient with COVID-19

One of the most feared complications of COVID-19 is respiratory failure caused by acute respiratory distress syndrome. In order to improve oxygenation and survival, patients admitted to intensive care units and intubated may undergo prone position mechanical ventilation. Prolonged prone positioning may cause meralgia paraesthetica due to lateral femoral cutaneous nerve entrapment between the inguinal ligament and the anterior superior iliac spine. Reports of the first two cases have been recently published.

We describe the case of a 52-year-old man with respiratory failure during COVID-19 infection, who underwent prone position ventilation for 16 hours a day over 19 days and developed persistent burning pain and dysaesthesia on the lateral surface of the thigh bilaterally, diagnosed as meralgia paraesthetica.

This is the second report describing meralgia paraesthetica following prone position ventilation in COVID-19. Given the ongoing pandemic and the inevitability of more patients with severe respiratory distress requiring prone position ventilation, this disabling entrapment condition should be considered and possibly prevented.

COVID-19 may require intubation and mechanical ventilation because of respiratory distress.Prone position ventilation improves oxygenation, but may cause lateral femoral cutaneous nerve entrapment and meralgia paraesthetica.Medical personnel should be aware of the risk of meralgia paraesthetica as a disabling condition potentially affecting more patients as the COVID-19 pandemic persists.