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B214 Tibial fracture, acute compartment syndrome and vasospasm – a case for nerve blocks?
  1. C Bergek
  1. Department of Paediatric Anaesthesia and Intensive Care; Queen Silvia’s Paediatric Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden


Background and Aims Acute compartment syndrome (ACS) is debated among surgeons and anaesthetists because of fear of masking symptoms. But using it properly the vasodilating effects of a nerve block can be very helpful.

Methods A 9 year old boy, 35 kg, had a diaphyseal tibial fracture (Figure1) and distal ischaemia. The fracture was reduced and secured with elastic nails. Swelling was diminished by this but the foot still ischaemic, deemed to be caused by arterial spasm. A short acting popliteal sciatic block (16 ml Lidocaine 10 mg/ml) followed to alleviate spasm but to no effect on foot perfusion, and also no increased swelling subjectively. Compartment pressure measurements followed 10–15 minutes later confirming ACS. (Figure 2, table 1) Fasciotomies were performed, finding swollen, viable muscles, but no improvement of circulation in the foot ensued.

Abstract B214 Table 1

Results To also cover nervous supply from the femoral nerve we then did an adductor canal block (8 ml Levobupivacaine 2,5 mg/ml) and within five minutes the colour and pulsations in the foot were normalized. To secure vasodilation and analgesia nerve block catheters were inserted to the sciatic nerve and adductor canal. On day five the nails were exchanged for external fixation, fasciotomies closed and catheters withdrawn. External fixation was removed after three months. There were no complications. The patient and parents expressed satisfaction with the treatments and agreed to publication of this report.

Conclusions Fracture, vasospasm and ACS can occur concomitantly, especially in children1,2. Nerve blocks to treat vasospasm is an interesting treatment modality, as in other cases of vasospasm3,4.

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