Sir,
The goal of the surgical position is to provide optimal visualization of, and access to, the surgical site that causes the least physiological compromise of the patient, while also protecting the skin and joints. When the patient has been administered anesthetic agents, the ability for the patient to communicate pain and pressure to the surgical team is eliminated; therefore, the team now becomes responsible for the patient to ensure the positioning has been conducted in a safe manner, and the integumentary, musculoskeletal, respiratory, and circulatory system functions have been preserved. Mal-positioning of the patient has important implications in terms of associated problems of pressure sores, nerve compressions, deep vein thrombosis, and compartment syndrome, and should be avoided. We report an incidence of venous congestion of lower limb of a patient posted for hip replacement in the lateral position, timely observation, and intervention prevented the mishap.
A 55-year-old male, weighing 84 kg, was scheduled to undergo left hip replacement under combined spinal and epidural block. After inducing anesthesia, the patient was secured in left lateral position with the help of anterior pubic support and posterior sacral support.[1] This was followed by scrubbing and prepping the lower limb to be operated, consuming about 15 min. Before the surgeon started draping, we noticed mottling and congestion of the right dependent limb [Figure 1]. On keen observation, we noticed the anterior pubic support had slipped downward from pubic symphysis to the inguinal region. This displacement led to compression of the femoral vessels in the femoral triangle. The support was removed which relieved the compression and mottling [Figure 2]. Since the entire episode occurred before draping, we could save the limb from catastrophic complications such as impairment of venous return, edema, and neuropraxia, and finally arterial compromise leading to gangrene if left unattended for a long time. Conventionally, tapes were used instead of the metallic supports which did not have chances of displacement and even if displaced, did not give rise to such consequences. There is one case report where a similar incident is discussed in the lateral position in two obese patients where the abdominal fat made the anterior pubic support prone to displacement and led to similar complications.[2,3] We report this incident in a nonobese patient which is rare, an incident which emphasizes the importance of vigilance and observation at every step, albeit the advancing technology.
Figure 1.
Picture denoting venous congestion
Figure 2.
Venous congestion relieved
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Conflicts of interest
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References
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