Perioperative peroneal neuropathy is an uncommon complication following surgeries performed with patients positioned supine. It may be caused by various factors aside from intraoperative compression. The authors report a case of common peroneal nerve palsy in a patient who underwent total thyroidectomy with central and bilateral selective neck dissection. The patient’s body mass index was 31.3 kg/m2. She was positioned supine and the operative time was 7-h. During surgery, her mean arterial pressure intermittently dropped to 50-60 mmHg for 55 min and 61-70 mmHg for 195 min. She developed common peroneal nerve palsy on postoperative day 1. Nevertheless, the patient fully recovered without any complications within 3 weeks.
Common peroneal nerve palsy; Hypotension; Supine position; Total thyroidectomy
Common peroneal nerve palsy that occurs in the perioperative period is usually caused by compression, traction, or ischemia. Thus, peroneal neuropathy is an uncommon complication in patients who undergo surgery in the supine position. In the rare instances it does occur, most involve patients who spend extended periods in the intensive care unit following procedures such as liver transplantation or cardiac surgery, and/or those with risk factors for neuropathy.
In the case described here, the patient experienced common peroneal nerve palsy following total thyroidectomy with central and bilateral selective neck dissection. We believe that common peroneal nerve palsy is associated with prolonged surgery times, obesity, and lower extremity hypoperfusion due to intraoperative hypotension.