DOI: 10.1111/tog.12064 2014;16:29–36 Review The Obstetrician & Gynaecologist http://onlinetog.org Nerve injuries associated with gynaecological surgery a b, a Olayemi Kuponiyi MRCOG, Djavid I Alleemudder MRCOG MRCS(Ed) BSc, * Adeyinka Latunde-Dada BMBS BMedSci, c Padma Eedarapalli MD MRCOG aSpecialist Trainee, Queen Alexandra Hospital, Southwick Hill Road, Cosham, Portsmouth PO6 3LY, UK. bSpecialist Trainee, Salisbury NHS Trust, Odstock Road, Salisbury SP2 8BJ, UK. cConsultant Obstetrician & Gynaecologist, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK *Correspondence: Djavid Alleemudder. Email:
[email protected] Accepted on 24 September 2013 Key content Learning objectives Nerve injuries are a common complication of gynaecological To gain an overview of the spectrum of different neuropathies that surgery, occurring in 1.1–1.9% of cases. may occur following pelvic surgery. Patient mal-positioning, incorrect placement of self-retaining To learn about safe surgical techniques in the prevention of retractors, haematoma formation and direct nerve entrapment or postoperative neuropathies. transection are the primary causative factors in perioperative To review the clinical anatomy of the lumbo-sacral and nerve injury. brachial plexuses. Nerves most commonly injured during surgery include the Ethical issues femoral, ilioinguinal, pudendal, obturator, lateral cutaneous, Neuropathies can cause considerable postoperative morbidity. iliohypogastric and genitofemoral nerves. Should neuropathies following gynaecology surgery be discussed The majority of neuropathies resolve with conservative routinely during consent taking? management and physiotherapy. Neuropathies following surgery may have considerable Selective serotonin reuptake inhibitors (SSRIs), tricyclic medico-legal implications. antidepressants and gamma-aminobutyric acid (GABA) antagonists are of significant benefit in managing Keywords: gynaecological surgery / nerve injury / neuropathy painful neuropathies.