Haemodynamic effects of adding ephedrine to propofol and alfentanil.

To the Editor: Crosby et al. present a case of permanent neurological dysfunction following abdominal aneurysectomy and attribute it to a lumbosacral plexopathy caused by an iliopsoas haematoma. ~ I agree with the authors that there is sufficient reason to believe that the iliopsoas haematomas are at least partially responsible for the deficits seen in the femoral and lateral femoral cutaneous nerves (i.e. lumbar plexus). Their conclusion is supported by the extensive literature review they present and by a review of the relevant anatomy. However, I believe that they should refer to the observed neurological dysfunction as a lumbar plexopathy. There is little reason to believe that the iliopsoas haematoma is responsible for deficits seen in the distribution of the "entire" sciatic nerve. While the lumbosacral "trunk" (technically a part of the lumbar plexus at the level of the pelvic brim) may, in theory, be compressed by a large psoas haematoma, it is extremely unlikely that the rest of the sacral plexus would be affected in like manner. The deficits in the sacral divisions of the sciatic nerve (sacral plexus) likely have an alternative explanation as suggested by the authors (i.e. vascular compression or vessel rupture). Therefore, I believe that the latter should be referred to as a sacral plexopathy to avoid confusion and that the combined terminology "lumbar and sacral plexopathy" be used to emphasize the disparate etiologies for the two pathological entities especially as the aetiology of the sacral plexopathy is unclear!