The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020)

Markus C. Fleisch; Werner Bader; Kai Balzer; Luisa Bennefeld; Carsten Boeing; Dorothee Bremerich; Paul Gass; Verena Geissbuehler; Martin C. Koch; Monika J. Nothacker; Klaus Pietzner; Stefan P. Renner; Thomas Römer; Stephan Roth; Florian Schütz; Wilhelm Schulte-Mattler; Jalid Sehouli; Kristina Lippach; Karl Tamussino; Alexander Teichmann; Clemens Tempfer; Marc Thill; Hans-Rudolf Tinneberg; Konstantinos Zarras

doi:10.1055/a-1378-4209

Geburtshilfe und Frauenheilkunde, Table of Contents

Geburtshilfe Frauenheilkd 2021; 81(04): 447-468
DOI: 10.1055/a-1378-4209

GebFra Science

Guideline/Leitlinie

The Prevention of Positioning Injuries During Gynecologic Surgery. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Registry Number 015/077, October 2020)

Article in several languages: English | deutsch

Markus C. Fleisch

¹Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany

,

Werner Bader

²Zentrum für Frauenheilkunde, Klinikum Bielefeld Mitte, Bielefeld, Germany

,

Kai Balzer

³Klinik für Gefäßchirurgie, GFO Kliniken, Bonn, Germany

,

Luisa Bennefeld

¹Landesfrauenklinik, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany

,

Carsten Boeing

⁴Klinik für Gynäkologie und Geburtshilfe, AMEOS Klinikum St. Clemens Oberhausen, Oberhausen, Germany

,

Dorothee Bremerich

⁵Klinik für Anästhesiologie, Universitätsklinikum Mainz, Mainz, Germany

,

Paul Gass

⁶DGGG Leitliniensekretariat, Germany

,

Verena Geissbuehler

⁷Department für Gynäkologie, St. Claraspital Basel, Basel, Switzerland

,

Martin C. Koch

⁸Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany

,

Monika J. Nothacker

⁹AWMF-Institut für Medizinisches Wissensmanagement, Universität Marburg, Marburg, Germany

,

Klaus Pietzner

¹⁰Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany

,

Stefan P. Renner

¹¹Frauenklinik, Klinikum Böblingen, Böblingen, Germany

,

Thomas Römer

¹²Frauenklinik, Evangelisches Krankenhaus Weyertal, Köln, Germany

,

Stephan Roth

¹³Klinik für Urologie, HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany

,

Florian Schütz

¹⁴Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany

,

Wilhelm Schulte-Mattler

¹⁵Klinik für Neurologie, Universitätsklinikum Regensburg, Regensburg, Germany

,

Jalid Sehouli

¹⁰Charité Frauenklinik, Universitätsmedizin Berlin, Berlin, Germany

,

Kristina Lippach

¹⁶Pflegewissenschaften und Praxisentwicklung, LMU München, München, Germany

,

Karl Tamussino

¹⁷Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Graz, Graz, Austria

,

Alexander Teichmann

¹⁸Sichuan Center for Gynaecology and Breast Surgery, Dept. of Perinatal Medicine, Medical University of Southwest China, Luzhou (Sichuan), China

,

Clemens Tempfer

¹⁹Klinik für Frauenheilkunde und Geburtshilfe, Marienhospital Herne, Universitätsklinikum Bochum, Bochum/Herne, Germany

,

Marc Thill

²⁰Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany

,

Hans-Rudolf Tinneberg

²¹Frauenklinik, Nordwest Krankenhaus, Frankfurt am Main, Germany

,

Konstantinos Zarras

²²Abteilung für Allgemein-, Viszeral- und Minimalinvasive Chirurgie des VVKD Marienhospitals Düsseldorf, Düsseldorf, Germany

› Author Affiliations

Abstract

Purpose Positioning injuries are relatively common, forensically highly relevant complications of gynecologic surgery. The aim of this official AWMF S2k-guideline is to provide statements and recommendations on how to prevent positioning injuries using the currently available literature. The literature was evaluated by an interdisciplinary group of experts from professional medical societies. The consensus on recommendations and statements was achieved in a structured consensus process.

Method The current guideline is based on the expired S1-guideline, which was updated by a systematic search of the literature and a review of relevant publications issued between February 2014 and March 2019. Statements were compiled and voted on by a panel of experts.

Recommendations The guideline provides general and specific recommendations on the prevention, diagnosis and treatment of positioning injuries.

Key words

gynecologic surgery - positioning injuries - prevention

Full Text

References

References
1 Bommert M, Wagner JK, Sehouli J. et al. Perioperative management of positioning in gynecological cancersurgery: a national NOGGO-AGO intergroup survey. Int J Gynecol Cancer 2020; 30: 1589-1594
2 Warner MA. Perioperative neuropathies. Mayo Clin Proc 1998; 73: 567-574
3 Loorham-Battersby C. Heel Damage And Epidural Analgesia. Are the two linked?. Saarbrücken: LAP LAMBERT Academic Publishing; 2012
4 Peterson T, Wissing H. Lagerungsschäden beim Patienten mit unbekanntem „thoracic outlet syndrome“. Anästhesiol Intensivmed Notfallmed Schmerzther 1995; 30: 516-518
5 Stevens J, Nichelson E, Linehan WM. et al. Risk factors for skin breakdown after renal and adrenal surgery. Urology 2004; 64: 246-249
6 Bauer ECA, Koch N, Janni W. et al. Compartment syndrome after gynecologic operations: evidence from case reports and reviews. Eur J Obstet Gynecol Reprod Biol 2014; 173: 7-12
7 Warner MA, Warner DO, Harper CM. et al. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000; 93: 938-942
8 Vereinbarung über die Zusammenarbeit in der operativen Gynäkologie und in der Geburtshilfe der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin und des Berufsverbands Deutscher Anästhesisten mit der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe und dem Berufsverband der Frauenärzte. 1996 Accessed March 30, 2020 at: https://www.bda.de/docman/alle-dokumente-fuer-suchindex/oeffentlich/empfehlungen/536-eev-2011-s-19-24/file.html
9 Weissauer W. Abgrenzung der Verantwortung für die operative Lagerung des Patienten und Haftung für Lagerungsschäden. Unfallchirurg 2002; 105: 404-412
10 Association of Perioperative Registered Nurses. Recommended practices for positioning the patient in the perioperative practice setting. AORN J 2001; 73: 231-235 237–238. Erratum in: AORN J 2001; 74: 201 Erratum in: AORN J 2001; 74: 201
11 Practice advisory for the prevention of perioperative peripheral neuropathies: a report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology 2000; 92: 1168-1182
12 (AST) Association of surgical technologists (AST). AST recommended Standards of Practice for Surgical Positioning, 2011. Accessed March 27, 2020 at: https://www.ast.org/uploadedFiles/Main_Site/Content/About_Us/Standard Surgical Positioning.pdf
13 Cluver C, Novikova N, Hofmeyr GJ. et al. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev 2013; (03) CD007623
14 Cohen MM, Duncan PG, Pope WD. et al. A survey of 112,000 anaesthetics at one teaching hospital (1975–83). Can Anaesth Soc J 1986; 33: 22-31
15 Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol 2005; 63: 5-18 discussion 18
16 Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 2010; 17: 414-420
17 Reich H. Laparoscopic treatment of extensive pelvic adhesions, including hydrosalpinx. J Reprod Med 1987; 32: 736-742
18 Romanowski L, Reich H, McGlynn F. et al. Brachial plexus neuropathies after advanced laparoscopic surgery. Fertil Steril 1993; 60: 729-732
19 Cheney FW, Domino KB, Caplan RA. et al. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999; 90: 1062-1069
20 Kretschmer T, Heinen CW, Antoniadis G. et al. Iatrogenic nerve injuries. Neurosurg Clin N Am 2009; 20: 73-90 vii
21 Bradshaw AD, Advincula AP. Optimizing patient positioning and understanding radiofrequency energy in gynecologic surgery. Clin Obstet Gynecol 2010; 53: 511-520
22 Zhang J, Moore AE, Stringer MD. Iatrogenic upper limb nerve injuries: a systematic review. ANZ J Surg 2011; 81: 227-236
23 Eteuati J, Hiscock R, Hastie I. et al. Brachial plexopathy in laparoscopic-assisted rectal surgery: a case series. Tech Coloproctol 2013; 17: 293-297
24 Advincula AP, Song A. The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 2007; 19: 331-336
25 JACKSON L, KEATS AS. MECHANISM OF BRACHIAL PLEXUS PALSY FOLLOWING ANESTHESIA. Anesthesiology 1965; 26: 190-194
26 Britt BA, Gordon RA. PERIPHERAL NERVE INJURIES ASSOCIATED WITH ANAESTHESIA. Can Anaesth Soc J 1964; 11: 514-536
27 Cooper DE, Jenkins RS, Bready L. et al. The prevention of injuries of the brachial plexus secondary to malposition of the patient during surgery. Clin Orthop Relat Res 1988; (228) 33-41
28 Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: a review of 22 cases. Br J Anaesth 1997; 79: 440-445
29 Suozzi BA, Brazell HD, OʼSullivan DM. et al. A comparison of shoulder pressure among different patient stabilization techniques. Am J Obstet Gynecol 2013; 209: 478.e1-478.e5
30 Coppieters MW. Shoulder restraints as a potential cause for stretch neuropathies: biomechanical support for the impact of shoulder girdle depression and arm abduction on nerve strain. Anesthesiology 2006; 104: 1351-1352
31 Klauschie J, Wechter ME, Jacob K. et al. Use of anti-skid material and patient-positioning to prevent patient shifting during robotic-assisted gynecologic procedures. J Minim Invasive Gynecol 2010; 17: 504-507
32 Haupt WF. Intraoperative Lagerungsschäden des Nervus ulnaris bei anatomischen Varianten. Dtsch Med Wochenschr 1989; 114: 1789-1792
33 Warner MA, Warner DO, Matsumoto JY. et al. Ulnar neuropathy in surgical patients. Anesthesiology 1999; 90: 54-59
34 Padua L, Aprile I, Caliandro P. et al. Natural history of ulnar entrapment at elbow. Clin Neurophysiol 2002; 113: 1980-1984
35 Stoelting RK. Postoperative ulnar nerve palsy–is it a preventable complication?. Anesth Analg 1993; 76: 7-9
36 Burkhart FL, Daly JW. Sciatic and peroneal nerve injury: a complication of vaginal operations. Obstet Gynecol 1966; 28: 99-102
37 Aschemann D. Hrsg. OP-Lagerungen für Fachpersonal. Heidelberg: Springer; 2009
38 Roy S, Levine AB, Herbison GJ. et al. Intraoperative positioning during cesarean as a cause of sciatic neuropathy. Obstet Gynecol 2002; 99: 652-653
39 Umo-Etuk J, Yentis SM. Sciatic nerve injury and caesarean section. Anaesthesia 1997; 52: 605-606
40 Batres F, Barclay DL. Sciatic nerve injury during gynecologic procedures using the lithotomy position. Obstet Gynecol 1983; 62 (3 Suppl.): 92s-94s
41 McQuarrie HG, Harris JW, Ellsworth HS. et al. Sciatic neuropathy complicating vaginal hysterectomy. Am J Obstet Gynecol 1972; 113: 223-232
42 Cherian RP, Li Y. Clinical and Electrodiagnostic Features Of Nontraumatic Sciatic Neuropathy. Muscle Nerve 2019; 59: 309-314
43 Chan JK, Manetta A. Prevention of femoral nerve injuries in gynecologic surgery. Am J Obstet Gynecol 2002; 186: 1-7
44 Hopper CL, Baker JB. Bilateral femoral neuropathy complicating vaginal hysterectomy. Analysis of contributing factors in 3 patients. Obstet Gynecol 1968; 32: 543-547
45 Räber G, Schneider HP. Femoralisparese nach vaginaler Hysterektomie und ihre forensische Bedeutung. Zentralbl Gynakol 1993; 115: 273-278
46 al Hakim M, Katirji B. Femoral mononeuropathy induced by the lithotomy position: a report of 5 cases with a review of literature. Muscle Nerve 1993; 16: 891-895
47 Roblee MA. Femoral neuropathy from the lithotomy position: case report and new leg holder for prevention. Am J Obstet Gynecol 1967; 97: 871-872
48 Sinclair RH, Pratt JH. Femoral neuropathy after pelvic operation. Am J Obstet Gynecol 1972; 112: 404-407
49 Koç G, Tazeh NN, Joudi FN. et al. Lower extremity neuropathies after robot-assisted laparoscopic prostatectomy on a split-leg table. J Endourol 2012; 26: 1026-1029
50 Goldman JA, Feldberg D, Dicker D. et al. Femoral neuropathy subsequent to abdominal hysterectomy. A comparative study. Eur J Obstet Gynecol Reprod Biol 1985; 20: 385-392
51 Litwiller JP, Wells RE, Halliwill JR. et al. Effect of lithotomy positions on strain of the obturator and lateral femoral cutaneous nerves. Clin Anat 2004; 17: 45-49
52 Lindner A, Schulte-Mattler W, Zierz S. Postpartales Nervus obturatorius-Syndrom: Fallbericht und Ubersicht über die Nervenkompressionssyndrome während Schwangerschaft und Geburt. Zentralbl Gynakol 1997; 119: 93-99
53 Fleisch MC. Risiken der Anwendung von Koagulationsgeräten im kleinen Becken. Gynäkologe 2016; 49: 888-890 doi:10.1007/s00129-016-3953-7
54 Liu P, He W, Chen H-L. Diabetes mellitus as a risk factor for surgery-related pressure ulcers: a meta-analysis. J Wound Ostomy Continence Nurs 2012; 39: 495-499
55 Connor T, Sledge JA, Bryant-Wiersema L. et al. Identification of pre-operative and intra-operative variables predictive of pressure ulcer development in patients undergoing urologic surgical procedures. Urol Nurs 2010; 30: 289-295 305
56 Lindholm C, Sterner E, Romanelli M. et al. Hip fracture and pressure ulcers – the Pan-European Pressure Ulcer Study – intrinsic and extrinsic risk factors. Int Wound J 2008; 5: 315-328
57 Edwards JL, Pandit H, Popat MT. Perioperative analgesia: a factor in the development of heel pressure ulcers?. Br J Nurs 2006; 15: S20-S25
58 Scott EM, Leaper DJ, Clark M. et al. Effects of warming therapy on pressure ulcers–a randomized trial. AORN J 2001; 73: 921-927 929–933, 936–938
59 EPUAP/NPUAP. Prävention und Behandlung von Dekubitus: Kurzfassung der Leitlinie, 2014. Accessed March 27, 2020 at: https://www.epuap.org/wp-content/uploads/2016/10/german_quick-reference-guide.pdf
60 Moore ZE, Patton D. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev 2019; (01) CD006471
61 McInnes E. The use of pressure-relieving devices (beds, mattresses and overlays) for the prevention of pressure ulcers in primary and secondary care. J Tissue Viability 2004; 14: 4-6 8, 10 passim
62 Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP). Expertenstandard Dekubitusprophylaxe in der Pflege. 2. Aktualisierung, 2017. Accessed March 22, 2021 at: https://www.dnqp.de/fileadmin/HSOS/Homepages/DNQP/Dateien/Expertenstandards/Dekubitusprophylaxe_in_der_Pflege/Dekubitus_2Akt_Auszug.pdf
63 Nicosia G, Gliatta AE, Woodbury MG. et al. The effect of pressure-relieving surfaces on the prevention of heel ulcers in a variety of settings: a meta-analysis. Int Wound J 2007; 4: 197-207
64 Cullum N, Nelson EA, Flemming K. et al. Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy. Health Technol Assess 2001; 5: 1-221
65 Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA 2006; 296: 974-984
66 Adler LM, Loughlin JS, Morin CJ. et al. Bilateral compartment syndrome after a long gynecologic operation in the lithotomy position. Am J Obstet Gynecol 1990; 162: 1271-1272
67 Lawrenz B, Kraemer B, Wallwiener D. et al. Lower extremity compartment syndrome after laparoscopic radical hysterectomy: brief report of an unusual complication of laparoscopic positioning requirements. J Minim Invasive Gynecol 2011; 18: 531-533
68 Schofield PF, Grace RH. Acute compartment syndrome of the legs after colorectal surgery. Colorectal Dis 2004; 6: 285-287
69 Halliwill JR, Hewitt SA, Joyner MJ. et al. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology 1998; 89: 1373-1376
70 Bauer ECA, Koch N, Erichsen CJ. et al. Survey of compartment syndrome of the lower extremity after gynecological operations. Langenbecks Arch Surg 2014; 399: 343-348
71 Martin JT. Compartment syndromes: concepts and perspectives for the anesthesiologist. Anesth Analg 1992; 75: 275-283
72 Svendsen LB, Flink P, Wøjdemann M. et al. Muscle oxygen saturation during surgery in the lithotomy position. Clin Physiol 1997; 17: 433-438
73 Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth 2009; 102: 3-11
74 Pfeffer SD, Halliwill JR, Warner MA. Effects of lithotomy position and external compression on lower leg muscle compartment pressure. Anesthesiology 2001; 95: 632-636
75 Mars M, Hadley GP. Failure of pulse oximetry in the assessment of raised limb intracompartmental pressure. Injury 1994; 25: 379-381
76 Wey JM, Guinn GA. Ulnar nerve injury with open-heart surgery. Ann Thorac Surg 1985; 39: 358-360
77 AWMF. S3 Leitlinie „Vermeidung perioperativer Hypothermie“. Aktualisierung 2019. Accessed March 30, 2020 at: https://www.awmf.org/uploads/tx_szleitlinien/001-018l_S3_Vermeidung_perioperativer_Hypothermie_2019-08.pdf