Background and Aims Acute compartment syndrome is a surgical emergency, and must be identified promptly in order to limit potential complications. The use of regional anaesthesia remains controversial for patients who are at higher risk of developing compartment syndrome due to concerns that the cardinal symptoms may be masked, and diagnosis subsequently delayed. This is a case report of a clinical situation which opposes this theory.
Methods A 31 year old male presented to a major trauma centre following a road traffic accident. Radiological imaging showed he had sustained multiple injuries, including a closed right tibia and fibula fracture and an extensive left calf laceration which required operative management. A lumbar epidural was inserted for intra-operative and postoperative analgesia, prior to the patient undergoing IM nail fixation of the right tibial fracture and exploration of the left leg laceration under general anaesthesia.
Results The lumbar epidural provided good analgesia which was maintained with a continuous infusion of 0.125% levobupivacaine and 2mcg/ml fentanyl. Fourteen hours postoperatively, this patient developed severe right lower limb pain. Intra-compartmental pressures were measured at this stage, where it was noted that anterior compartment pressures were abnormal and the patient underwent urgent fasciotomy under general anaesthesia. Operative findings at this time were consistent with a diagnosis of compartment syndrome, with maintained viable muscle tissue present on examination.
Conclusions This case demonstrates support for alternative theories that regional anaesthetic techniques using low concentrations may provide effective analgesia without the risk of masking the presentation of acute compartment syndrome.
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