Suspicion of Postanesthetic Femoral Paralysis of the Non-Dependent Limb in a Horse.
Authors: Mirra Alessandro, Klopfenstein Bregger Micaël David, Levionnois Olivier Louis
Journal: Frontiers in veterinary science
Summary
# Editorial Summary A 15-year-old Selle Français gelding undergoing surgical treatment for left guttural pouch mycosis developed unexpected neurological dysfunction in the non-dependent (left hind) limb during recovery from general anaesthesia, presenting a clinically important case of postanesthetic femoral neuropathy. The horse had been positioned in right lateral recumbency on a padded surgical table with controlled hypotension (mean arterial pressure 60–70 mmHg) maintained during carotid and maxillary artery manipulation; despite four unsuccessful attempts to stand, the gelding eventually rose at 120 minutes post-anaesthesia but exhibited moderate ataxia, complete inability to bear weight on the left hind limb, and bilateral stifle and fetlock flexion contractures that prevented normal foot placement. Notably, the affected limb showed no heat, pain, swelling, or muscular tension on examination, yet the horse demonstrated exaggerated flexion with marked abduction when voluntarily moving the leg, consistent with femoral nerve rather than musculoskeletal compromise. Supportive management including sling therapy, compression bandaging, and anti-inflammatory medication led to complete recovery within 3 days, but the underlying pathophysiology remained unclear since the non-dependent limb was not subjected to direct pressure or positional stretch during surgery. For equine practitioners, this case highlights that postanesthetic neuropathy affecting the non-dependent limb must be considered in recovery complications even when conventional risk factors are absent, and appropriate supportive care rather than forced mobilisation appears beneficial during the acute neurological phase.
Read the full abstract on PubMed
Practical Takeaways
- •Monitor for neuropathy affecting the non-dependent limb after general anesthesia, not just the dependent limb, as this is an underrecognized complication
- •If a horse shows inability to bear weight on a limb with flexed joints post-recovery, suspect postanesthetic neuropathy and initiate supportive care (sling, bandaging, NSAIDs) while allowing time for spontaneous recovery
- •Recovery from postanesthetic neuropathy can be complete within days with conservative management, so avoid hasty euthanasia decisions in apparent paralysis cases
Key Findings
- •A 15-year-old horse developed moderate ataxia and absence of weight bearing on the non-dependent left hind limb 120 minutes after general anesthesia for guttural pouch surgery
- •Clinical signs included flexed stifle and fetlock joints with inability to extend properly, exaggerated motion with marked abduction, but no pain or heat on palpation
- •The horse fully recovered within 3 days with sling support, supportive bandaging, and flunixine administration
- •Non-dependent limb neuropathy should be considered as a postanesthetic complication even after ruling out common causes of postanesthetic lameness