Meralgia Paresthetica: COVID-19-associated ARDS treated with prone positioning

ccforum.biomedcentral.com February 3, 2021

Prone positioning is one of the few interventions in acute respiratory distress syndrome (ARDS) which has a proven mortality reduction.

Due to the coronavirus disease 2019 (COVID-19) pandemic, severe ARDS cases have sharply increased worldwide, increasing the need for proning. Some centers have also encouraged non-intubated patients with hypoxemia due to COVID-19 to self-prone.

Although generally considered low risk, pressure-related complications can occur during proning and differ from those that occur in supine patients.

We present two cases of COVID-19-associated ARDS treated with prone positioning who developed meralgia paresthetica that was diagnosed in our ICU recovery clinic. Meralgia paresthetica (MP) results from compression injury of the lateral femoral cutaneous nerve between the anterior superior iliac spine and the inguinal ligament; this mononeuropathy results in sensory abnormalities in the anterolateral thigh.

To our knowledge, there is only one other reported case of MP in prone positioning for ARDS, although it has been reported after surgical prone positioning in up to 24% of cases