Background. Compartment syndrome involving the lower extremity is a rare complication of surgical procedures that incorporate the lithotomy position. In patients who are at risk for this complication, the safety of using postoperative epidural anesthesia with local anesthetics has been questioned because of the difficulty in recognizing compartment syndrome with ongoing epidural blockade.

Results. The authors describe a case of lower extremity compartment syndrome that developed after a radical cystectomy with the patient in the lithotomy position. Prompt recognition occurred despite the use of epidural anesthesia with bupivacaine and fentanyl.