Effect of operation time on lower extremity muscle activity in lithotomy position

The lithotomy position is one of the positions in which the patients are laid down for surgical operations in the lower abdomen, anorectal region, pelvis, vaginal area, and medical examination. In this position, the thighs are bent to the level of the hips and the legs are placed on a footrest and slightly opened outwards. Long operations where the patients are kept in the lithotomy position might cause impaired blood circulation in the lower extremities and femoral and peroneal nerve injuries. The lithotomy position might create external pressures due to the anatomical localization of the peroneal nerve. Since its course is superficial, these external pressures occur most often at the head of fibula. In the literature, it has been reported that the incidence of lower extremity sensory and motor dysfunction due to neurological damage in obstetric cases varies between 0.008% and 0.5%, and complications such as diminished muscle strength occur due to this dysfunction. The complications detected in the clinic include foot drop due to weakness in the foot dorsiflexors and difficulty in walking due to it. Approximately 31% of neurogenic drop foot cases develop due to peroneal nerve damage. In this study, we aim to analyze the activation of the muscles innervated by the femoral and peroneal nerves. In the innervation of the femoral nerve, hip flexion of the iliopsoas, knee extension of the rectus femoris from the quadriceps femoris muscle group, and the activity of the tibialis anterior muscle of the foot dorsiflexion as a function of the peroneal branch of the sciatic nerve were examined. The recording method of the electromyography (EMG) data with superficial electrodes was performed without time limitation, with a wide field of view, painless, and without increasing the risk of hematoma and infection. In this prospective study, the relationship between EMG data and operation time was analyzed while measuring muscle in the preoperative and postoperative periods of the patients who undergo gynecological surgery in the lithotomy position at the Department of Obstetrics and Gynecology, in Antalya Training and Research Hospital. The patients' demographic, clinical, and operative data were compared. In order to preoperative and postoperative period surface EMG data of the patients who underwent surgery in the lithotomy position were examined that the muscle activity in the quadriceps femoris, iliopsoas and tibialis anterior muscle groups after 24-hour post-operative period was significantly reduced when compared to the pre-operative period.