Regional anesthesia and acute compartment syndrome: principles for practice

Abstract

Acute compartment syndrome (ACS) is a potentially reversible orthopedic surgical emergency leading to tissue ischemia and ultimately cell death. Diagnosis of ACS can be challenging, as neither clinical symptoms nor signs are sufficiently sensitive. The cardinal symptom associated with ACS is pain reported in excess of what would otherwise be expected for the underlying injury, and not reasonably managed by opioid-based analgesia. Regional anesthesia (RA) techniques are traditionally discouraged in clinical settings where the development of ACS is a concern as sensory and motor nerve blockade may mask symptoms and signs of ACS. This Education article addresses the most common trauma and elective orthopedic surgical procedures in adults with a view towards assessing their respective risk of ACS and offering suggestions regarding the suitability of RA for each type of surgery.

In reply

“…We thank Drs Suarez and Holman for their comments1 on our recent educational article discussing the suitability of regional anesthesia for common orthopedic procedures that may be associated with acute compartment syndrome (ACS) 2. We agree with Drs Suarez and Holman that adequate analgesia is of paramount importance for all patients undergoing surgery and we appreciate their concern for the subset of patients who have suffered tibial shaft fractures.…”

Response to ‘Regional anesthesia and acute compartment syndrome: principles for practice’

“…We contrast the assertions of Dwyer et al 1 with the recent guidance produced by the Association of Anesthetists of Great Britain and Ireland on the use of RA in lower leg trauma 7. In their appendix, they have summarized the available literature and reference 5 systematic reviews, 16 case reports and 1 case series.…”

“…We read with interest the recent educational article by Dwyer et al 1 regarding the use of regional anesthesia (RA) in those with acute compartment syndrome (ACS). They suggest that RA should not be used in cases of tibial shaft fracture, high-energy tibial plateau fractures and two-bone forearm fractures.…”

Concerns regarding “Regional anesthesia and acute compartment syndrome: principles for practice”

“…The article by Dwyer et al entitled “Regional anesthesia and acute compartment syndrome: principles for practice” summarizes the most common trauma and elective orthopedic surgical procedures in adults associated with the development of acute compartment syndrome (ACS), stratifies relative ACS risk, and offers recommendations for the use of regional anesthesia (RA) in these cases 1. The article provides valuable information for the anesthesiologist and pain management team, emphasizing the importance of early identification of ACS.…”