Look for Early Signs of Postsurgical Nerve Injuries.

PALM BEACH, FLA. - Nerve injuries as a result of gynecologic surgery can often be successfully treated if they are caught early But most gynecologists are not even aware of how common these injuries are, Dr. Michael Baggish said at an ob.gyn. meeting sponsored by the University of Chicago.

One prospective study of 100 women undergoing hysterectomy showed a 7% incidence of nerve injuries when EMG and nerve conduction studies were done postsurgically (Br. J. Obstet. Gynaecol. 102[8]:665-66, 1995).

"I think it happens much more often than we even know," Dr. Baggish, professor of ob.gyn. at the University of Cincinnati, told this newspaper.

But if gynecologists are aware of this potential problem and alert to any signs of it after surgery, many patients could be successfully treated with physical therapy.

"Usually the complaint will occur within a couple of days after surgery--almost always 24 hours or more after--because most patients won't be getting up before that," he said.

Patients typically complain of weakness, pain or numbness, and, in severe cases, they may have trouble standing or walking. "Not uncommonly the nurses may dismiss this at first as part of the patient's recovery But if a thorough exam is done with a neurologist, the physical signs of the neuropathy can be easily picked up," he said.

The two most common causes of nerve injuries are improper positioning of patients for gynecologic surgery (the lithotomy and Trendelenburg's positions are the most dangerous) and the careless use of abdominal self-retaining retractors.