Peroneural neuropathy after total hip arthroplasty with combined neural block: a case report

• Published in: Journal of Japan Society of Pain Clinicians Vol. 28; no. 9; pp. 194 - 198
• Main Authors: NISHIWAKI, Kimitoshi, TAMURA, Takahiro, KINUKAWA, Tomoaki Alex, SEKI, Taisuke, TAKEGAMI, Yasuhiko
• Format: Journal Article
• Language: Japanese
• Published: Japan Society of Pain Clinicians 25.09.2021; 一般社団法人 日本ペインクリニック学会
• Subjects: lumbar plexus block; perioperative neuropathy; peroneal neuropathy; sciatic nerve block; total hip arthroplasty; 人工股関節全置換術; 周術期神経障害; 坐骨神経ブロック; 腓骨神経麻痺; 腰神経叢ブロック
• ISSN: 1340-4903; 1884-1791
• DOI: 10.11321/jjspc.21-0029

A 46-year-old woman, 157 cm 58 kg, underwent left total hip arthroplasty after lumbar plexus block and sciatic nerve block via the parasacral approach. Postoperative X-ray revealed 20-mm leg extension. After surgery, both legs had movement disorder and sensory disturbance, which improved within a few hours. Lumbar plexus block was considered to be an epidural block. Thereafter, sensory and motor disorders slightly improved, but recovery of dorsiflexion movement of the left ankle joint was delayed and mild peroneal neuropathy at the level of the peroneal head was diagnosed by electromyography 28 days after surgery. Thirty-two days after surgery, the patient was discharged with stable walking using a cane. The neurological symptoms were suspected to be caused by physical factors, such as hyperextension of the peroneal nerve, because the neuropathy was at the level of the peroneum. We also cannot exclude the possibility that this nerve block affected paralysis.