A case of meralgia paresthetica caused by prone positioning in a COVID-19 patient with acute respiratory distress syndrome


Submitted: 1 December 2021
Accepted: 21 December 2021
Published: 29 March 2022
Abstract Views: 602
PDF: 177
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Authors

  • Tahsin Karaaslan Department of Nephrology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
  • Aysenur Avarisli Department of Neurology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey.
  • Bulent Durdu Department of Anesthesia and Reanimation, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey.
  • Hayrettin Daskaya Department of Infectious Diseases, Bezmialem Vakif University, Medical Faculty, Istanbul, Turkey.

COVID-19 critically ill patients usually require prone positioning for the treatment of respiratory failure caused by Acute Respiratory Distress Syndrome (ARDS). Prone position provides a better ventilation-perfusion compatibility, resulting in a significant improvement in oxygenation and a decrease in mortality, but prolonged prone positioning may cause Meralgia Paresthetica (MP), one of the most common mononeuropathies of the lower limb. The early diagnosis of MP is crucial to avoid a permanent damage with pain and disability, and to start immediately the correct treatment. In this article, we report a rare case of MP in a critically ill COVID-19 patient with ARDS, with the main aim to create awareness for MP among the medical team working.


Chen X, Tian J, Li G, et al. Initiation of a new infection control system for the COVID-19 outbreak. Lancet Infect Dis 2020;20:397-8. DOI: https://doi.org/10.1016/S1473-3099(20)30110-9

Sohrabi C, Alsafi Z, O'Neill N, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg 2020;76:71-6. DOI: https://doi.org/10.1016/j.ijsu.2020.02.034

Hassan SA, Sheikh FN, Jamal S, et al. Coronavirus (COVID-19): A review of clinical features, diagnosis, and treatment. Cureus 2020;12:e7355. DOI: https://doi.org/10.7759/cureus.7355

Sadacharan C. Microanatomy of the lateral femoral cutaneous nerve in relation to inguinal ligament and its clinical importance. Medical Express 2016;3:M160106. DOI: https://doi.org/10.5935/MedicalExpress.2016.01.06

Cansü E, Yücel İ, Özturan K. Meralgia paresthetica: Case report in a policeman. J Med Duzce 2010;12:67-9.

Grossman MG, Ducey SA, Nadler SS, et al. Meralgia paresthetica: diagnosis and treatment. J Am Academy Orth Surg 2001;9:336-44. DOI: https://doi.org/10.5435/00124635-200109000-00007

Kaiser R. Meralgia paresthetica. Rozhledy v chirurgii: mesicnik Ceskoslovenske chirurgicke spolecnosti 2018;97:286-290.

Chen CK, Phui VE, Saman MA. Alcohol neurolysis of lateral femoral cutaneous nerve for recurrent meralgia paresthetica. Agri 2012;24:42-4. DOI: https://doi.org/10.5505/agri.2012.47450

Langford B, Mauck WD. Peripheral nerve stimulation: A new treatment for meralgia paresthetica. Pain Med 2021;22:213-6. DOI: https://doi.org/10.1093/pm/pnaa326

Juhl CS, Ballegaard M, Bestle MH, et al. Meralgia paresthetica after prone positioning ventilation in the intensive care unit. Case Rep Critical Care 2016;2016:7263201. DOI: https://doi.org/10.1155/2016/7263201

Wongmek A, Shin S, Zhou L. Skin biopsy in assessing meralgia paresthetica. Muscle Nerve 2016;53:641-3. DOI: https://doi.org/10.1002/mus.25044

Yang SH, Wu CC, Chen PQ. Postoperative meralgia paresthetica after posterior spine surgery: incidence, risk factors, and clinical outcomes. Spine 2005;30:E547-550. DOI: https://doi.org/10.1097/01.brs.0000178821.14102.9d

Philip CN, Candido KD, Joseph NJ, et al. Successful treatment of meralgia paresthetica with pulsed radiofrequency of the lateral femoral cutaneous nerve. Pain Physician 2009;12:881-5. DOI: https://doi.org/10.36076/ppj.2009/12/881

Pollard CA, Morran MP, Nestor-Kalinoski AL. The COVID-19 pandemic: a global health crisis. Physiol Genomics 2020;52:549-57. DOI: https://doi.org/10.1152/physiolgenomics.00089.2020

Hanley B, Lucas SB, Youd E, et al. Autopsy in suspected COVID-19 cases. J Clin Pathol 2020;73:239-42. DOI: https://doi.org/10.1136/jclinpath-2020-206522

Ellul MA, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767-83. DOI: https://doi.org/10.1016/S1474-4422(20)30221-0

Douglas WW, Rehder K, Beynen FM, et al. Improved oxygenation in patients with acute respiratory failure: The prone position. Am Rev Respir Dis 1977;115:559-66.

Paternoster G, Sartini C, Pennacchio E, et al. Awake pronation with helmet continuous positive airway pressure for COVID-19 acute respiratory distress syndrome patients outside the ICU: A case series. Med Intensiva 2020;S0210-5691(20)30273-4.

Lee JM, Bae W, Lee YJ, et al. The efficacy and safety of prone positional ventilation in acute respiratory distress syndrome: updated study-level meta-analysis of 11 randomized controlled trials. Critical Care Med 2014;42:1252-62. DOI: https://doi.org/10.1097/CCM.0000000000000122

Bastoni D, Poggiali E, Vercelli A, et al. Prone positioning in patients treated with non-invasive ventilation for COVID-19 pneumonia in an Italian emergency department. Emerg Med J 2020;37:565-6. DOI: https://doi.org/10.1136/emermed-2020-209744

Richards H, Robins-Browne K, O'Brien T, et al. Clinical benefits of prone positioning in the treatment of non-intubated patients with acute hypoxic respiratory failure: a rapid systematic review. Emerg Med J 2021;38:594-9. DOI: https://doi.org/10.1136/emermed-2020-210586

Nersesjan V, Amiri M, Lebech AM, et al. Central and peripheral nervous system complications of COVID-19: a prospective tertiary center cohort with 3-month follow-up. J Neurol 2021;268:3086–104. DOI: https://doi.org/10.1007/s00415-020-10380-x

Christie F, Quasim T, Cowan R, et al. Meralgia paraesthetica in intensive care unit survivors of COVID-19. Anaesthesia 2021;76:712-3. DOI: https://doi.org/10.1111/anae.15355

Serrano Barrenechea L, Nordin J, Sörbo A. [Meralgia paresthetica after prolonged prone position at the intensive care unit among COVID-19 patients. A case report]. Lakartidningen 2021;118:20163.

Nouraei SA, Anand B, Spink G, et al. A novel approach to the diagnosis and management of meralgia paresthetica. Neurosurg 2007;60:696-700. DOI: https://doi.org/10.1227/01.NEU.0000255392.69914.F7

Karaaslan, T., Avarisli, A., Durdu, B., & Daskaya, H. (2022). A case of meralgia paresthetica caused by prone positioning in a COVID-19 patient with acute respiratory distress syndrome. Emergency Care Journal, 18(1). https://doi.org/10.4081/ecj.2022.10310

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