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Evolving Compartment Syndrome Not Masked by a Continuous Peripheral Nerve Block: Evidence-Based Case Management
  1. Benjamin J. Walker, MD*,
  2. Kenneth J. Noonan, MD and
  3. Adrian T. Bosenberg, MBChB, FFA(SA)
  1. From the *Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI;
  2. Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI; and
  3. Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA.
  1. Address correspondence to: Benjamin J. Walker, MD, Department of Anesthesiology, B6/319 CSC, 600 Highland Dr, Madison, WI 53792 (e-mail: bjwalker2{at}


Abstract Compartment syndrome is a potentially devastating complication of many orthopedic surgeries. Whether regional anesthesia can delay the diagnosis of compartment syndrome remains a subject of debate. Previous case reports have described compartment syndrome primarily in the setting of an epidural infusion, but also following single-injection peripheral nerve blocks. A case of evolving compartment syndrome in an ambulatory setting that was not masked by a continuous peripheral nerve block is presented, followed by a discussion of the literature pertaining specifically to peripheral nerve blockade and the diagnosis of compartment syndrome. Diagnosis depends on close postoperative monitoring of analgesic use and pain trends, and patients with ambulatory catheters require thorough education about compartment syndrome so they can be evaluated in a timely manner. The current literature on compartment syndrome diagnosis and regional anesthesia is limited to case reports and expert opinion, making evidence-based recommendations difficult.

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  • No funding was required for this report. The report was submitted from the Department of Anesthesiology at the University of Washington, where this case occurred while Dr. Walker was a fellow there.

  • This case report was presented in abstract form at the American Society for Regional Anesthesia and Pain Medicine Annual Meeting, Toronto, Ontario, Canada, April 2010, and the Society for Pediatric Anesthesia Spring Meeting, San Antonio, Texas, April 2010.