The Prevention of Positioning Injuries during Gynecologic Operations. Guideline of DGGG (S1-Level, AWMF Registry No. 015/077, February 2015)

Abstract

Purpose: Official guideline published and coordinated by the German Society of Gynecology and Obstetrics (DGGG). Positioning injuries after lengthy gynecological procedures are rare, but the associated complications can be potentially serious for patients. Moreover, such injuries often lead to claims of malpractice and negligence requiring detailed medical investigation. To date, there are no binding evidence-based recommendations for the prevention of such injuries. Methods: This S1-guideline is the work of an interdisciplinary group of experts from a range of different professions who were commissioned by DGGG to carry out a systematic literature search of positioning injuries. Members of the participating scientific societies develop a consensus in an informal procedure. Afterwards the directorate of the scientific society approves the consensus. The recommendations cover:

Zusammenfassung

Ziel: Offizielle Leitlinie, publiziert und koordiniert von der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Lagerungsschäden nach langdauernden gynäkologischen Eingriffen sind seltene aber für die Patientin potenziell schwerwiegende Komplikationen. Zudem sind sie nicht selten Anlass für medizinische Gutachten und gerichtliche Auseinandersetzungen. Bis dato existieren keine verbindlichen, evidenzbasierten Empfehlungen zur Prävention. Methoden: Die vorliegende S1-Leitlinie ist das Ergebnis der Arbeit einer interdisziplinären und interprofessionellen Expertengruppe, die im Auftrag der Leitlinienkommission der DGGG eine systematische Literaturrecherche zum Thema durchgeführt hat. Mitglieder der beteiligten Fachgesellschaften entwickeln in einem informellen Prozess einen Konsensus. Anschließend bestätigen die Direktorien der Fachgesellschaften diesen Konsensus. Die Empfehlungen berücksichtigen:

Key words

gynecologic operations - positioning injuries - prevention

Schlüsselwörter

gynäkologische Eingriffe - Lagerungsschäden - Prävention

• References

• 1 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. Frauenarzt 1996; 37: 1172-1177
• 2 AORN. Recommended Practices for positioning the Patient in the perioperative Practice Setting. In: AORN, Hrsg. Perioperative Standards and recommended Practices. Denver: AORN Inc.; 2014
• 3 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
• 4 AST Recommended Standards of Practice for Surgical Positioning.. Online: http://www.ast.org last access: 01.01.2014
• 5 EPUAP/NPUAP. Leitlinie Dekubitusprävention.. Online: http://www%20epuab%20org last access: 01.01.2014
• 6 DEUTSCHES NETZWERK FÜR QUALITÄTSENTWICKLUNG IN DER PFLEGE (DNQP). Expertenstandard Dekubitusprophylaxe in der Pflege. 2010.. Online: http://www.dnqp.de last access: 01.01.2014
• 7 Larsen R. Lagerung des Patienten zur Operation. In: Larsen R, Hrsg. Anästhesie. München, Jena: Urban und Fischer; 2006
• 8 Clarke AM, Stillwell S, Paterson ME et al. Role of the surgical position in the development of postoperative low back pain. J Spinal Disord 1993; 6: 238-241
• 9 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
• 10 Frezza EE. The lithotomy versus the supine position for laparoscopic advanced surgeries: a historical review. J Laparoendosc Adv Surg Tech A 2005; 15: 140-144
• 11 Hammond DC, Hollender HA, Bouwense CL. The sit-up position in breast surgery. Plast Reconstr Surg 2001; 107: 572-576
• 12 Warner MA, Martin JT, Schroeder DR et al. Lower-extremity motor neuropathy associated with surgery performed on patients in a lithotomy position. Anesthesiology 1994; 81: 6-12
• 13 Warner MA, Warner DO, Harper CM et al. Lower extremity neuropathies associated with lithotomy positions. Anesthesiology 2000; 93: 938-942
• 14 Aschemann D. OP-Lagerungen für Fachpersonal. Heidelberg: Springer Medizin Verlag; 2009
• 15 Weissauer W. Abgrenzung der Verantwortung für die operative Lagerung des Patienten und Haftung für Lagerungsschäden. Anaesthesist 2002; 51: 166-174
• 16 Baur R, Schwenzer T. Der Lagerungsschaden bei Operationen – ein tatsächlich voll beherrschbares Risiko? GesR 5/2013, 272 – 276.
• 17 Kienzle F, Ullrich W, Krier C. Lagerungsschäden in Anästhesie und operativer Intensivmedizin (Teil 2). Anasthesiol Intensivmed Notfallmed Schmerzther 1997; 32: 72-86
• 18 Berg D, Bauer H, Broglie M, Ulsenheimer K, Zwißler B. medizin.recht. Berlin: Verlag S. Kramarz; 2013
• 19 Cluver C, Novikova N, Hofmeyer GJ et al. Maternal position during caesarean section for preventing maternal and neonatal complications. Cochrane Database Syst Rev 2010; (6) CD007623
• 20 Warner MA, Warner ME, Martin JT. Ulnar neuropathy. Incidence, outcome, and risk factors in sedated or anesthetized patients. Anesthesiology 1994; 81: 1332-1340
• 21 Liu P, He W, Chen HL. Diabetes mellitus as a risk factor for surgery-related pressure ulcers: a meta-analysis. J Wound Ostomy Continence Nurs 2012; 39: 495-499
• 22 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
• 23 Loorham-Battersby CM, McGuiness W. Heel damage and epidural analgesia: is there a connection?. J Wound Care 2011; 20: 28 30, 32–34
• 24 Peterson T, Wissing H. Lagerungsschäden beim Patienten mit unbekanntem „thoracic outlet syndrome“. Anasthesiol Intensivmed Notfallmed Schmerzther 1995; 30: 516-518
• 25 Stevens J, Nichelson E, Linehan WM et al. Risk factors for skin breakdown after renal and adrenal surgery. Urology 2004; 64: 246-249
• 26 Bauer EC, 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
• 27 Cardosi RJ, Cox CS, Hoffman MS. Postoperative neuropathies after major pelvic surgery. Obstet Gynecol 2002; 100: 240-244
• 28 Winfree CJ, Kline DG. Intraoperative positioning nerve injuries. Surg Neurol 2005; 63: 5-18
• 29 Sunderland S. A classification of peripheral nerve injuries producing loss of function. Brain 1951; 74: 491-516
• 30 Bradshaw AD, Advincula AP. Optimizing patient positioning and understanding radiofrequency energy in gynecologic surgery. Clin Obstet Gynecol 2010; 53: 511-520
• 31 Kaye AH. Classification of Nerve Injuries. In: Kaye AH, Hrsg. Essential Neurosurgery. New York: Churchill Livingstone; 1991: 333-334
• 32 AWMF S3-Leitlinie „Versorgung peripherer Nervenverletzungen“.. Online: http://www.awmf.org/leitlinien/detail/ll/005-010.html last access: 01.01.2014
• 33 Shveiky D, Aseff JN, Iglesia CB. Brachial plexus injury after laparoscopic and robotic surgery. J Minim Invasive Gynecol 2010; 17: 414-420
• 34 Reich H. Laparoscopic treatment of extensive pelvic adhesions, including hydrosalpinx. J Reprod Med 1987; 32: 736-742
• 35 Romanowski L, Reich H, McGlynn F et al. Brachial plexus neuropathies after advanced laparoscopic surgery. Fertil Steril 1993; 60: 729-732
• 36 Cheney FW, Domino KB, Caplan RA et al. Nerve injury associated with anesthesia: a closed claims analysis. Anesthesiology 1999; 90: 1062-1069
• 37 Kretschmer T, Heinen CW, Antoniadis G et al. Iatrogenic nerve injuries. Neurosurg Clin N Am 2009; 20: 73-90 vii
• 38 Zhang J, Moore AE, Stringer MD. Iatrogenic upper limb nerve injuries: a systematic review. ANZ J Surg 2011; 81: 227-236
• 39 Eteuati J, Hiscock R, Hastie I et al. Brachial plexopathy in laparoscopic-assisted rectal surgery: a case series. Tech Coloproctol 2013; 17: 293-297
• 40 Advincula AP, Song A. The role of robotic surgery in gynecology. Curr Opin Obstet Gynecol 2007; 19: 331-336
• 41 Jackson L, Keats AS. Mechanism of brachial plexus palsy following anesthesia. Anesthesiology 1965; 26: 190-194
• 42 Britt BA, Gordon RA. Peripheral nerve injuries associated with anaesthesia. Can Anaesth Soc J 1964; 11: 514-536
• 43 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
• 44 Ben-David B, Stahl S. Prognosis of intraoperative brachial plexus injury: a review of 22 cases. Br J Anaesth 1997; 79: 440-445
• 45 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
• 46 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
• 47 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
• 48 Mitterschiffthaler G, Theiner A, Posch G et al. Läsion des Plexus brachialis, verursacht durch fehlerhafte Operationslagerungen. Anasth Intensivther Notfallmed 1987; 22: 177-180
• 49 Haupt W. Intraoperative Lagerungsschäden des Nervus ulnaris bei anatomischen Varianten. Dtsch Med Wochenschr 1998; 114: 1789-1792
• 50 Warner MA, Warner DO, Matsumoto JY et al. Ulnar neuropathy in surgical patients. Anesthesiology 1999; 90: 54-59
• 51 Kastrup O. Diagnostik und Therapie der chronischen Ulnarisneuropathie am Ellenbogen (ulnarneuropathy at the elbow, UNE). In: Diener HC, Weimar C, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. Stuttgart: Thieme; 2012
• 52 Stoelting RK. Postoperative ulnar nerve palsy–is it a preventable complication?. Anesth Analg 1993; 76: 7-9
• 53 Burkhart FL, Daly JW. Sciatic and peroneal nerve injury: a complication of vaginal operations. Obstet Gynecol 1966; 28: 99-102
• 54 Roy S, Levine AB, Herbison GJ et al. Intraoperative positioning during cesarean as a cause of sciatic neuropathy. Obstet Gynecol 2002; 99: 652-653
• 55 Umo-Etuk J, Yentis SM. Sciatic nerve injury and caesarean section. Anaesthesia 1997; 52: 605-606
• 56 Batres F, Barclay DL. Sciatic nerve injury during gynecologic procedures using the lithotomy position. Obstet Gynecol 1983; 62: 92s-94s
• 57 McQuarrie HG, Harris JW, Ellsworth HS et al. Sciatic neuropathy complicating vaginal hysterectomy. Am J Obstet Gynecol 1972; 113: 223-232
• 58 Martin J. Positioning in Anaesthesia and Surgery. Philadelphia: WB Saunders; 1987
• 59 Dunnihoo D, Huddleston H, North S. Femoral nerve palsy as a complication of vaginal hysterectomy – review of the world literature. J Gynecol Surg 1994; 10: 1-6
• 60 Chan JK, Manetta A. Prevention of femoral nerve injuries in gynecologic surgery. Am J Obstet Gynecol 2002; 186: 1-7
• 61 Hopper CL, Baker JB. Bilateral femoral neuropathy complicating vaginal hysterectomy. Analysis of contributing factors in 3 patients. Obstet Gynecol 1968; 32: 543-547
• 62 Raber G, Schneider HP. [Femoral nerve paralysis after vaginal hysterectomy and its forensic importance]. Zentralbl Gynakol 1993; 115: 273-278
• 63 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
• 64 Roblee MA. Femoral neuropathy from the lithotomy position: case report and new leg holder for prevention. Am J Obstet Gynecol 1967; 97: 871-872
• 65 Sinclair RH, Pratt JH. Femoral neuropathy after pelvic operation. Am J Obstet Gynecol 1972; 112: 404-407
• 66 Koc 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
• 67 Warner MA. Perioperative neuropathies. Mayo Clin Proc 1998; 73: 567-574
• 68 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
• 69 Glenn J. Neural damage resulting from dorsal lithotomy positioning. Surg Rounds 1981; 4: 42-46
• 70 Litwiller JP, Wells jr. 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
• 71 Lindner A, Schulte-Mattler W, Zierz S. Postpartales Nervus obturatorius-Syndrom: Fallbericht und Übersicht über die Nervenkompressionssyndrome während Schwangerschaft und Geburt. Zentralbl Gynäkol 1997; 119: 93-99
• 72 Staff NP, Engelstad J, Klein CJ et al. Post-surgical inflammatory neuropathy. Brain 2010; 133: 2866-2880
• 73 Collier M, Moore Z. Pressure Ulcer Aetiology and Risk Factors. In: Romanelli M, ed. Science and Practice of Pressure Ulcers. London: Springer; 2006: 27-36
• 74 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
• 75 Edwards JL, Pandit H, Popat MT. Perioperative analgesia: a factor in the development of heel pressure ulcers?. Br J Nurs 2006; 15: S20-S25
• 76 Scott EM, Leaper DJ, Clark M et al. Effects of warming therapy on pressure ulcers–a randomized trial. AORN J 2001; 73: 921-933 936
• 77 Moore ZE, Cowman S. Risk assessment tools for the prevention of pressure ulcers. Cochrane Database Syst Rev 2014; (2) CD006471
• 78 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
• 79 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
• 80 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
• 81 Reddy M, Gill SS, Rochon PA. Preventing pressure ulcers: a systematic review. JAMA 2006; 296: 974-984
• 82 Krapfl LA, Gray M. Does regular repositioning prevent pressure ulcers?. J Wound Ostomy Continence Nurs 2008; 35: 571-577
• 83 Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev 2013; (8) CD009362
• 84 Schofield PF, Grace RH. Acute compartment syndrome of the legs after colorectal surgery. Colorectal Dis 2004; 6: 285-287
• 85 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
• 86 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
• 87 Szalay G, Meyer C, Alt V et al. Das lagerungsbedingte Kompartmentsyndrom des Unterschenkels als Komplikation nach Eingriffen in Steinschnittposition. Zentralbl Chir 2010; 135: 163-167
• 88 Tonnies P, Stogbauer R, Watermann D et al. Unterschenkel-Kompartmentsyndrom nach langdauernden gynäkologischen Operationen in Steinschnittlage. Zentralbl Gynakol 1999; 121: 149-152
• 89 Matsen 3rd FA, Krugmire jr. RB. Compartmental syndromes. Surg Gynecol Obstet 1978; 147: 943-949
• 90 Halliwill JR, Hewitt SA, Joyner MJ et al. Effect of various lithotomy positions on lower-extremity blood pressure. Anesthesiology 1998; 89: 1373-1376
• 91 Bauer EC, Koch N, Erichsen CJ et al. Survey of compartment syndrome of the lower extremity after gynecological operations. Langenbecks Arch Surg 2014; 399: 343-348
• 92 Martin JT. Compartment syndromes: concepts and perspectives for the anesthesiologist. Anesth Analg 1992; 75: 275-283
• 93 Horgan AF, Geddes S, Finlay IG. Lloyd-Davies position with Trendelenburg–a disaster waiting to happen?. Dis Colon Rectum 1999; 42: 916-919
• 94 Svendsen LB, Flink P, Wojdemann M et al. Muscle oxygen saturation during surgery in the lithotomy position. Clin Physiol 1997; 17: 433-438
• 95 Leff RG, Shapiro SR. Lower extremity complications of the lithotomy position: prevention and management. J Urol 1979; 122: 138-139
• 96 Tiwari A, Haq AI, Myint F et al. Acute compartment syndromes. Br J Surg 2002; 89: 397-412
• 97 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
• 98 Pfeffer SD, Halliwill JR, Warner MA. Effects of lithotomy position and external compression on lower leg muscle compartment pressure. Anesthesiology 2001; 95: 632-636
• 99 Mars M, Hadley GP. Failure of pulse oximetry in the assessment of raised limb intracompartmental pressure. Injury 1994; 25: 379-381
• 100 Tomassetti C, Meuleman C, Vanacker B et al. Lower limb compartment syndrome as a complication of laparoscopic laser surgery for severe endometriosis. Fertil Steril 2009; 92: 2038.e9-2038.e12
• 101 Wey JM, Guinn GA. Ulnar nerve injury with open-heart surgery. Ann Thorac Surg 1985; 39: 358-360
• 102 Zylicz Z, Nuyten FJ, Notermans SL et al. Postoperative ulnar neuropathy after kidney transplantation. Anaesthesia 1984; 39: 1117-1120