Anesthesia Technician Practice Exam

What is the most common cause of perioperative peroneal neuropathy in patients positioned in lithotomy?

1. Stretching of the nerve

2. Compression of the nerve by a leg holder

3. Direct pressure from the surgical table

4. Improper padding of the legs

The correct answer is: Compression of the nerve by a leg holder

The most common cause of perioperative peroneal neuropathy in patients positioned in lithotomy is the compression of the nerve by a leg holder. In this position, the legs are typically elevated and held in place, which can result in significant pressure on the common peroneal nerve, especially at the site where it winds around the fibula. This form of nerve compression occurs when the leg holder is not properly adjusted or when the extremities are not well supported, leading to prolonged pressure that can impair blood flow and directly impact nerve function. Compression injuries often manifest as sensory and motor deficits, particularly affecting the lower leg and foot, consistent with the clinical presentations seen in peroneal neuropathies. While stretching of the nerve and improper padding are also concerns in lithotomy positioning, the direct mechanical compression from leg holders is recognized as the primary mechanism that leads to neuropathy in this context. Direct pressure from the surgical table is less typical since the table is designed to provide general support and typically does not exert concentrated pressure in the way that improperly positioned leg holders can.