Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

Abstract

A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population.

Compartment syndrome and regional anaesthesia: Critical review

“…In the recently published systematic review by Driscoll et al 48 , the authors compared regional anaesthesia and the patient-controlled analgesia (PCA) in patients with compartment syndrome. Although they used different search methods and a different approach for considering the effect of anaesthesia and analgesia on the delay in ACS diagnosis, in 6/8 (75%) patients in the PCA group ACS was diagnosed with a delay compared to the RA group where delay in diagnosis was detected in 19/29 (65%) case reports (Table 1).…”

“…Although they used different search methods and a different approach for considering the effect of anaesthesia and analgesia on the delay in ACS diagnosis, in 6/8 (75%) patients in the PCA group ACS was diagnosed with a delay compared to the RA group where delay in diagnosis was detected in 19/29 (65%) case reports (Table 1). When comparing the possible influence of RA on delay in time (considering the evolution in regional anaesthesia -lower dosing, lower concentrations, ultrasound guidance), the more recently published data (after 2009) claimed that in 75% cases, no association between RA and delay in ACS was detected 48 .…”

“…One interesting observation can be found in Driscoll et al 48 , that most of the articles pinpointing the delay in ACS diagnosis on RA were published in surgical/orthopaedic journals and most of the articles defending RA were published in anaesthesiology journals, which corresponds daily clinical practice.…”

“…Every single analgesic method can be associated with the delay in ACS diagnosis if pain is the sole diagnostic criteria. As opioids (PCA) can lead to even higher incidence of delay compared to regional anesthesia 48 and it is highly unethical not to treat the pain, the complex management of the whole patient at risk of ACS appears to be more important than the analgesic method alone.…”

Acute compartment syndrome secondary to anterolateral thigh flap harvesting in a pediatric patient

“…Some physicians believed that regional anesthesia could put the patient at higher risk for devastating complications. [ 9 ] Preservation of the lateral femoral cutaneous nerve during ALT harvesting decreases the risk of ACS complications.…”