{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T11:42:59Z","timestamp":1764070979103,"version":"3.45.0"},"reference-count":12,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:00:00Z","timestamp":1764028800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Reports"],"abstract":"<jats:p>Background and Clinical Significance: Morbid obesity is a recognized risk factor for perioperative neuropathies, but simultaneous involvement of multiple peripheral nerves is rare. Case presentation: We report a 49-year-old woman (BMI 45) who underwent open total hysterectomy under combined general and epidural anesthesia in the supine position with Trendelenburg tilt. Despite preoperative positioning simulation, she developed postoperative numbness of the left fingers and bilateral upper limb weakness, followed by bilateral lower limb weakness and severe right thigh pain. Imaging excluded epidural hematoma. Iliopsoas weakness persisted despite epidural discontinuation. Rehabilitation and pregabalin partially improved symptoms, but sensory deficits and gait disturbance remained. At long-term follow-up, she was able to ambulate with a Lofstrand crutch, although right thigh numbness persisted. Two years postoperatively, diabetes mellitus was diagnosed. Conclusions: Morbid obesity may predispose to multiple perioperative neuropathies through mechanical compression and metabolic vulnerability. Careful intraoperative reassessment of pillow height, limb position, and retractor placement, combined with early recognition and multidisciplinary management, is essential to prevent neuropathy and optimize recovery.<\/jats:p>","DOI":"10.3390\/reports8040245","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T10:46:18Z","timestamp":1764067578000},"page":"245","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Multiple Postoperative Neuropathies in a Morbidly Obese Patient Undergoing Open Total Hysterectomy: A Case Report"],"prefix":"10.3390","volume":"8","author":[{"given":"Mugi","family":"Kawafune","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3481-2085","authenticated-orcid":false,"given":"Joho","family":"Tokumine","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3258-9310","authenticated-orcid":false,"given":"Harumasa","family":"Nakazawa","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0387-5406","authenticated-orcid":false,"given":"Kiyoshi","family":"Moriyama","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka 181-8611, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1016\/j.mayocp.2020.03.025","article-title":"Central obesity is associated with neuropathy in the severely obese","volume":"95","author":"Callaghan","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"240","DOI":"10.2337\/dc18-1842","article-title":"General and abdominal obesity and incident distal sensorimotor polyneuropathy: Insights into inflammatory biomarkers as potential mediators in the KORA F4\/FF4 cohort","volume":"42","author":"Schlesinger","year":"2019","journal-title":"Diabetes Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1097\/DCR.0000000000000037","article-title":"Obesity increases the risk of postoperative peripheral neuropathy after minimally invasive colon and rectal surgery","volume":"57","author":"Velchuru","year":"2014","journal-title":"Dis. Colon Rectum."},{"key":"ref_4","unstructured":"Dalton, A. (2025, September 14). Obesity and Robotic Surgery. Anesthesia Patient Safety Foundation. Available online: https:\/\/www.apsf.org\/article\/obesity-and-robotic-surgery\/."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.mayocp.2019.05.038","article-title":"Postsurgical Neuropathies: A Descriptive Review","volume":"95","author":"Laughlin","year":"2020","journal-title":"Mayo Clin. Proc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2866","DOI":"10.1093\/brain\/awq252","article-title":"Post-Surgical Inflammatory Neuropathy","volume":"133","author":"Staff","year":"2010","journal-title":"Brain"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s10397-021-01086-7","article-title":"Femoral nerve injury in gynecologic surgery: Medico-legal issues for best surgical practices","volume":"18","author":"Fedeli","year":"2021","journal-title":"Gynecol. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jmig.2016.09.004","article-title":"Nerve Injuries in Gynecologic Laparoscopy","volume":"24","author":"Abdalmageed","year":"2017","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Sheng, B., Feng, C., Zhang, D., Spitler, H., and Shi, L. (2017). Associations between Obesity and Spinal Diseases: A Medical Expenditure Panel Study Analysis. Int. J. Environ. Res. Public Health, 14.","DOI":"10.3390\/ijerph14020183"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Practice Advisory for the Prevention of Perioperative Peripheral Neuropathies 2018 (2018). An Updated Report by the American Society of Anesthesiologists Task Force on Prevention of Perioperative Peripheral Neuropathies. Anesthesiology, 128, 11\u201326.","DOI":"10.1097\/ALN.0000000000001937"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Chiaramonte, R., Pavone, V., Testa, G., Pesce, I., Scaturro, D., Musumeci, G., Mauro, G.L., and Vecchio, M. (2023). The Role of Physical Exercise and Rehabilitative Implications in the Process of Nerve Repair in Peripheral Neuropathies: A Systematic Review. Diagnostics, 13.","DOI":"10.3390\/diagnostics13030364"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.jht.2020.03.008","article-title":"Predictors of functional outcome after peripheral nerve injury and compression","volume":"34","author":"Stonner","year":"2021","journal-title":"J. Hand Ther."}],"container-title":["Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/245\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T11:38:34Z","timestamp":1764070714000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2571-841X\/8\/4\/245"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,25]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["reports8040245"],"URL":"https:\/\/doi.org\/10.3390\/reports8040245","relation":{},"ISSN":["2571-841X"],"issn-type":[{"value":"2571-841X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,25]]}}}