If the patient has severe hip or leg pain postoperatively, what should I suspect is wrong? How should I manage this complication?
The nerve to the levator ani runs within the coccygeus muscle. In a thin patient, in whom deep bites are taken, the nerve is often injured or trapped. Such trauma can cause hip pain that is fairly severe but that is almost always self-limiting and requires only nonsteroidal anti-inflammatory medication. Usually, this complication resolves within 2 weeks after surgery.
Significant postoperative pain that radiates down the back of the thigh or down the leg all the way to the foot is of greater concern because one of the sacral nerve segments has most likely been injured or stretched. Obtain a neurology consult; rarely, it becomes necessary to take the patient back to surgery to cut the offending suture.
*For detailed discussion of this subject, see the International Academy of Pelvic Surgery’s August 2010 “Case of the month” at www.academyofpelvicsurgery.com.
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