This week I saw a patient Day I Post radical prostectomy He had GA and the surgery was uncomplicated. He doesn’t have any relevant PMH. When I say him, his obs were stable, he had TED stockings, leg pumps and normal attachments. He was on PCA. When I took the leg pumps out he started to complain of numbness and P&N`s on his knees and superior 1/3 of legs. After SOEB those symptoms continued and he started to complain of involuntary movements on his Right knee (kn ext). His muscle strength on his quads and hamis were normal bilaterally and there were no signs that the leg pumps were too tight. Obviously, he got really anxious about that and frustrated because he thought he could stand up easily. I was with my supervisor and she said that she has never seen that before. We called the nurse and the doctor, but none of them had an explanation for that and said that we could continue the treatment. At the end, we stood up the patient, did a bit of stepping on the spot, but the patient was a bit unsteady so we put him back to bed.
Has anyone seen this happen before? Any ideas on the reason for those symptoms and how I could have managed that differently will be appreciated.
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Hello Caroline!
I have never seen something like this before but it’s definitely an interesting case with many interesting features! Especially when there’s no relevant PMH. I was just wondering what his age is and if there could be any psychological component? I was also wondering about his premorbid mobility and the reason why he also had the leg pumps in addition to the TEDs? I know that post-op patients will usually have TEDs on but he has the additional pumps (or is this just due to different protocols in different hospitals)? Perhaps we can search for information on complications post radical prostatectomy and see if that gives any clues? I am not exactly sure about the incision site, anatomy etc but is there any possibility of neurological involvement at all? I was just reminded of a ‘atypical’ patient (not the typical critically ill patient) previously in the ICU managed for an infected haematoma in his pecs after a fall who was really bad on his feet somehow (nil significant head injury that we knew of). We didn’t target his standing / balance specifically but just did our best to stand him up and walked everyday and eventually everything seemed to just resolve by itself and he was walking around freely! Hmmm, come to think of it, his initial presentation is still a question mark. Also, I was thinking for your patient, what medications is he taking and if those will cause any side effects? I would love to know what happened to this patient and his subsequent presentation during follow-ups!
Cheers Peiying ~
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