Skip to main content

Advertisement

SpringerLink
Log in

Peronäusläsionen nach KTEP-Implantation unter Verwendung einer postoperativ fortgeführten periduralen Analgesie

Peroneal nerve palsy after total knee arthroplasty under continuous epidural anaesthesia

  • Originalien
  • Published:
Der Orthopäde Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Entstehung einer postoperativen Peronäusparese ist eine schwerwiegende Komplikation bei der Implantation einer Knietotalendoprothese (KTEP). Nach Einführen einer standardisierten postoperativ fortgeführten Periduralanalgesie bei einem ansonsten unveränderten perioperativen Procedere kam es in unserem Haus zur plötzlichen Häufung von Peronäusparesen nach KTEP-Implantation.

Patienten und Methoden

In dieser retrospektiven Studie wurden verschiedene bekannte und z. T. umstrittene Risikofaktoren für die Entstehung von Nervenläsionen bei KTEP-Implantationen in der Literatur gesichtet und die Anamnese der Patienten diesbezüglich untersucht.

Ergebnisse

Es zeigten sich deutliche Hinweise auf eine additiv axonal schädigende Wirkung des periduralen Katheters (PDK), der perioperativen Lagerung des Beins und des Blutsperrenmanschettendruckes im Sinne eines Double-crush-Phänomens. Bei unverändertem PDK-Regime konnte durch Absenken des Blutsperrenmanschettendruckes und Lagerungsveränderung das Risiko einer Läsion des N. peroneus deutlich reduziert werden.

Schlussfolgerung

Um eine mögliche Schädigung des N. peroneus zu vermeiden, sollte bei Verwendung eines PDK zur KTEP-Implantation unbedingt ein zu hoher Blutsperrenmanschettendruck (>320 mmHg) vermieden werden und auf die druckfreie Lagerung des operierten Beins geachtet werden.

Abstract

Background

Peroneal nerve palsy is a rare but distressing complication of total knee arthroplasty (TKA). After introducing a standardised intraoperative and postoperative epidural anaesthesia protocol under otherwise unchanged perioperative management, we noted a sudden cumulation of peroneal nerve palsies after TKA.

Patients and methods

In this retrospective study we checked the patients’ histories for well-known risk factors for nerve lesions after TKA as well as for those risk factors controversially discussed in the literature.

Results

We found an additive harmful impact of epidural anaesthesia leading to unrecognised pressure on the peroneal nerve, which caused, in combination with a pressure lesion of the pneumatic tourniquet, an axonal lesion in terms of a double-crush syndrome. By lowering the pneumatic tourniquet pressure and carefully positioning the operated leg, we found a clearly reduced risk of nerve lesion while preserving the advantages of epidural anaesthesia for the patient.

Conclusion

To prevent a peroneal lesion after TKA while using continuous epidural anaesthesia, we strongly recommend limiting the pneumatic tourniquet pressure to 320 mmHg while ensuring pressure-free positioning of the operated leg.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Literatur

  1. Asp JP, Rand JA (1990) Peroneal nerve palsy after total knee arthroplasty. Clin Orthop 261: 233–237

    PubMed  Google Scholar 

  2. Dobner JJ, Nitz AJ (1982) Postmeniscectomy tourniquet palsy and functional sequelae. Am J Sports Med 10: 211–214

    Article  PubMed  CAS  Google Scholar 

  3. Enneking FK, Chan V, Greger J et al. (2005) Lower-extremity peripheral nerve blockade: essentials of our current understanding. Reg Anesth Pain Med 30: 4–35

    Article  PubMed  Google Scholar 

  4. Fanelli G, Casati A, Garancini P, Torri G (1999) Nerve stimulator and multiple injection technique for upper and lower limb blockade: failure rate, patient acceptance, and neurologic complications. Study Group on Regional Anesthesia. Anesth Analg 88: 847–852

    Article  PubMed  CAS  Google Scholar 

  5. Horlocker TT, Cabanela ME, Wedel DJ (1994) Does postoperative epidural analgesia increase the risk of peroneal nerve palsy after total knee arthroplasty? Anesth Analg 79: 495–500

    PubMed  CAS  Google Scholar 

  6. Horlocker TT, Hebl J, Gali B et al. (2006) Anesthetic, patient, and surgical risk factors for neurologic complications after prolonged total tourniquet time during total knee arthroplasty. Anesth Analg 102: 950–955

    Article  PubMed  Google Scholar 

  7. Idusuyi OB, Morrey BF (1996) Peroneal nerve palsy after total knee arthroplasty. Assessment of predisposing and prognostic factors. J Bone Joint Surg Am 78: 177–184

    PubMed  CAS  Google Scholar 

  8. Knutson K, Leden I, Sturfelt G et al. (1983) Nerve palsy after knee arthroplasty in patients with rheumatoid arthritis. Scand J Rheumatol 12: 201–205

    Article  PubMed  CAS  Google Scholar 

  9. Raj PP, Knarr DC, Vigdorth E et al. (1987) Comparison of continuous epidural infusion of a local anesthetic and administration of systemic narcotics in the management of pain after total knee replacement surgery. Anesth Analg 66: 401–406

    Article  PubMed  CAS  Google Scholar 

  10. Rose HA, Hood RW, Otis JC et al. (1982) Peroneal-nerve palsy following total knee arthroplasty. A review of The Hospital for Special Surgery experience. J Bone Joint Surg Am 64: 347–351

    PubMed  CAS  Google Scholar 

  11. Saleh KJ, Hoeffel DP, Kassim RA, Burstein G (2003) Complications after revision total knee arthroplasty. J Bone Joint Surg Am 85(Suppl 1): 71–74

    Google Scholar 

  12. Schinsky MF, Macaulay W, Parks ML et al. (2001) Nerve injury after primary total knee arthroplasty. J Arthroplasty 16: 1048–1054

    Article  PubMed  CAS  Google Scholar 

  13. Todd MM, Brown DL (1999) Regional anesthesia and postoperative pain management: long-term benefits from a short-term intervention. Anesthesiology 91: 1–2

    Article  PubMed  CAS  Google Scholar 

  14. Upton AR, McComas AJ (1973) The double crush in nerve entrapment syndromes. Lancet 2: 359–362

    Article  PubMed  CAS  Google Scholar 

  15. Hebl et al. (2001) Regional anesthesia does not increase the risk of postoperative neuropathy in patients undergoing ulnar nerve transposition. Anesth Analg 93: 1606–1611

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Orthopädische Klinik, Vincentius-Krankenhaus AG, Konstanz, Deutschland

    J. Beller, U. Trockel & M. Lukoschek

  2. Klinik für Orthopädie und Unfallchirurgie, Klinikum Stuttgart, Krankenhaus Bad Cannstatt, Prießnitzweg 24, 70374, Stuttgart, Deutschland

    J. Beller

Authors
  1. J. Beller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. U. Trockel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Lukoschek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Beller.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beller, J., Trockel, U. & Lukoschek, M. Peronäusläsionen nach KTEP-Implantation unter Verwendung einer postoperativ fortgeführten periduralen Analgesie. Orthopäde 37, 475–480 (2008). https://doi.org/10.1007/s00132-008-1257-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00132-008-1257-x

Schlüsselwörter

Keywords

Search

Navigation