Sequential Compression Device May Cause Peroneal Nerve Palsy

Abstract

This article presents 2 cases of foot drop after joint replacement surgery that presented after sequential compression device application. In both cases, intact peroneal nerve function was documented by the surgeon in the recovery room prior to sequential compression device application. We believe that excessive pressure over the superficial aspect of the peroneal nerve in conjunction with decreased pain stimulus from analgesia may have contributed to these complications. We maintain sequential compression devices are the current mechanical thromboprophylaxis of choice; however, 4 recommendations are made to minimize the chances of this potential complication. First, precise attention should be given to patients who are short statured, as these patients can be more susceptible to having a sequential compression device improperly placed over the peroneal nerve at the fibular neck. Second, we recommend different size options become more widely available to accommodate varying patient sizes such that placement of the device is ensured to be distal to the fibular neck. Third, when using sequential compression device brands that have hook and look fastener straps, the straps should not be tight on application and frequent skin checks should be made to look for signs of over-compression. Lastly, we recommend considering delaying postoperative application of the sequential compression device until resolution of sensation following spinal or epidural anesthetic.

Effect of gaiters on muscle pump activity in healthy volunteers

“…23 This high negative pressure gradient may result in a tourniquet effect such as oedema, pain or deep vein thrombosis at more distal regions due to disturbance of venous return. 25–27 However, from our previous study including the interface pressure measurement of various joint- or muscle-supporters for leg pain, 20 we consider that a tourniquet effect rarely occurs if the pressure difference is 10 mmHg or less, even if the compression pressure of the distal part is higher than that of the proximal part in the two adjoining parts. In the present study, as the gaiters were applied closely to the calf without extra tension, the interface pressure under the gaiters at the calf was less than 10 mmHg.…”