Pain Control with Regional Anesthesia in Patients at Risk of Acute Compartment Syndrome: Review of the Literature and Editorial View

Abstract

Acute compartment syndrome (ACS) is a devastating complication that can happen in almost every part of the human body, most noticeably after long bone fractures. The cardinal symptom of ACS is pain in excess of what would otherwise be expected from the underlying injury and unresponsive to routine analgesia treatment. There is paucity of literature on major analgesic management strategies including opioid analgesia, epidural anesthesia, and peripheral nerve blocks with regard to their differential efficacy and safety of pain management in patients at risk of developing ACS. The lack of quality data has led to recommendations that are perhaps more conservative than they should be, particularly when it comes to peripheral nerve blocks. In this review article, we attempt to make recommendations in favor of regional anesthesia in this vulnerable group of patients and strategies that will optimize adequate pain control and improve surgical outcome without jeopardizing patient safety.

Peripheral Nerve Stimulation for Treating Acute Pain Following Traumatic Fracture: A Case Report of Rapid-Onset Analgesia Without Motor Blockade

“…Tibial shaft fractures, as seen in our patient, are recognized as one of the highest-risk injuries for acute compartment syndrome [ 10 ]. There is a possibility that regional blockade or catheter placement may mask the pain of compartment syndrome, and their use is limited in some injuries [ 11 ]. Our regional anesthesia team sought to reduce persistent pain and opioid use in selected postoperative trauma patients by implementing percutaneous PNS as an adjunct to the aforementioned analgesic options.…”