Positional neuropathies in surgical oncology

Aim. To evaluate the frequency and clinical characteristics of positional neuropathies in patients with cancer who underwent surgery.

Materials and methods. A retrospective study of medical records of patients undergoing surgical treatment in 2023, who showed signs of secondary neuropathy of the upper and/or lower extremities in the postoperative period. The main analyzed parameter was the frequency of postoperative neuropathies among patients who underwent surgery; additional parameters were the degree of neurological deficit according to the neurological deficit assessment scale, the median regression of neurological deficit.

Results. The study included 29 patients who underwent surgery at the National Medical Research Center of Oncology named after N. N. Blokhin in 2023, who developed a clinical picture of positional neuropathy in the postoperative period. The overall incidence of positional neuropathies was 0.28 %. Neuropathies of the brachial plexus were predominant (96 %). A severe degree of neurological deficit was noted in 35 %, medium – in 45 %, mild – in 20 % of patients. 27.5 % of patients continued to have varying degrees of neurological deficit over a 10-month period.

Conclusion. Positional neuropathies can persist for a long time; it is necessary to develop methods for their prevention.

1. Gladyshev D.V., Moiseev M.E., Kovalenko S.A. et al. Robotassisted extralevatory abdominoperineal et al.extirpation of the rectum with transabdominal levator transaction in a patient in lithotomy position. Onkologicheskaya koloproktologiya = Oncological Coloproctology 2017(1):18–26. (In Russ.).

2. Chatkov I.E., Barsukov Yu.A., Atroshchenko A.O. et al. History of laparoscopic surgery. Onkologicheskaya koloproktologiya = Oncological Coloproctology 2012;(2):35–9. (In Russ.).

3. Fedorov S. A., Kichin V.V., Sungurov V.A., Lixvancev V.V. Positional disorders in the practice of an anesthesiologist. Vestnik intensivnoj terapii im. A.I. Saltanova = Annals of Critical Care 2014;(1):20–25. (In Russ.).

4. Cheney F.W. The American Society of Anesthesiologists Closed Claims Project: what have we learned, how has it affected practice, and how will it affect practice in the future? Anesthesiology 1999;91(2):552–6. DOI: 10.1097/00000542-199908000-00030

5. Kroll D.A., Caplan R.A., Posner K. et al. Nerve injury associated with anesthesia. Anesthesiology 1990;73(2):202–7. DOI: 10.1097/00000542-199008000-00002

6. Cheney F.W., Domino K.B., Caplan R.A., Posner K.L. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999;90(4):1062–9. DOI: 10.1097/00000542-199904000-00020

7. Practice advisory for the prevention of perioperative peripheral neuropathies 2018: an updated report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology 2018;128:11–26. DOI: https://doi.org/10.1097/ALN.0000000000001937

8. Aids to the examination of the peripheral nervous system. Medical Research Council. London, 1976.

9. Bjoro B., Mykkeltveit I., Rustoen T. et al. Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery – a systematic review. J Adv Nurs 2020;76(2):490–503. DOI: 10.1111/jan.14271

10. Navarro-Vicente F., García-Granero A., Frasson M. et al. Prospective evaluation of intraoperative peripheral nerve injury in colorectal surgery. Colorectal Dis 2012;14(3):382–5. DOI: 10.1111/j.1463-1318.2011.02630.x