ABSTRACT : Prolonged lithotomy position has been blamed for common peroneal neuropathy and transient neurological symptoms related to pressure and compression.Here we have discussed about recognition,treatment and prevention.

METHODS : A 45 year old female with normal pre anaesthetic evaluation underwent elective mayowards hysterectomy under spinal anaesthesia with Inj.Bupivacaine(hyperbaric)2.2cc+Inj.Fentanyl(25mcg).Intra operative course was uneventful.Patient was haemodynamicallystable.Surgery lasted for 3 hours. The next day of surgery after she started ambulating, she complained of difficulty to walk without support and weakness in both lower limbs,not associated with pain.Neurological examination showed bilateral weakness in dosiflexion and sluggish ankle jerk.X ray and MRI-LS spine were normal.Nerve conduction study showed decreased conduction in bilateral common peronealnerves.She was treated with steroids and hydroxyl methyl cobalamin and physiotherapy.She was discharged with complete recovery on 15th post operative day.

RESULTS : Bilateral weakness of lower limbs due to lithotomy position under spinal is a well documentedcomplication.Possibility of direct trauma to peripheral nerve or spinal cord trauma should be ruled out.Risk factors include duration of lithotomy>3hours,BMI<20.Compression of common peroneal nerve at head of fibula due to direct pressure of metal rod causes neuropathy. We recommend preventing nerve compression by using soft cotton padding between metal rod and leg to decrease pressure on nerve.

CONCLUSIONS : Peripheral nerve injuries are a complication of anaesthesia related to position and operative procedure,which is accounted for medicolegal claims and difficult to defend.Earlyrecognition,investigation and treatment can prevent this complication.