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Abstract
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Background and Aims Peripheral neuropathies are a relatively common complication after CABG surgery, occurring in about 10-15%. Most frequently affected nerves are the brachial plexus, phrenic nerve, recurrent laryngeal nerve, and saphenous nerve. Similarly, after cardiac catheterization with transfemoral access (TFA), the incidence of limb dysfunction ranges from 0.004% to 0.21%, with thigh cutaneous nerves being affected in 0.04% of cases.
Methods ASA3, 51-year-old female with PMH: coronary artery disease who underwent redo-CABG with femoral vascular cannulation for cardiopulmonary bypass post-NSTEMI, under GA. The surgery was uneventful, but on POD2, the patient complained of moderate neuropathic pain in her right thigh, which worsened with movement and preventing ambulation. Examination revealed sensory deficits in the distribution of the intermediate cutaneous nerve of the thigh (ICNT), no motor deficit. Increasing pregabalin dose, didn’t provide relief. An USG-ICNT block successfully alleviated the pain, the patient was discharged with mild pain under medication.
Results The ICNT is a branch of the femoral nerve and is vulnerable to injury during TFA. Symptoms typically manifest with a delay of approximately 37 hours and include sensory deficits and severe pain. Motor neuropathy may also occur. The exact cause of nerve injury is multifactorial. Prompt recognition and appropriate management are crucial for optimal patient outcomes, avoiding unnecessary suffering and potential discharge delays.
Intermediate cutaneous nerve of the thigh US
Conclusions Conclusion: Surgeons should be mindful of the potential for ICNT injury during inguinal cannulation in redo-CABG procedures. Early diagnosis and effective pain management are essential in ensuring the best possible outcomes for patients. 10.1055/s-0043-121628 10.1253/circj.CJ-18-0389 (Circ J 2018; 82: 2736–2744) 10.1016/B978-0-444-63599-0.00031-4