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Regional anesthesia and acute compartment syndrome: principles for practice
  1. Tim Dwyer1,2,3,
  2. David Burns4,
  3. Aaron Nauth1,5,
  4. Kaitlin Kawam4 and
  5. Richard Brull6
  1. 1Department of Surgery, University of Toronto Division of Orthopaedics, Toronto, Ontario, Canada
  2. 2Department of Surgery, Women’s College Hospital, Toronto, Ontario, Canada
  3. 3Department of Surgery, Mt Sinai Hospital, Toronto, Ontario, Canada
  4. 4University of Toronto Division of Orthopaedics, Toronto, Ontario, Canada
  5. 5Department of Surgery, St Michael’s Hospital, Toronto, Ontario, Canada
  6. 6Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Dr Tim Dwyer, Department of Surgery, University of Toronto, Division of Orthopaedics, Women's College Hospital, 76 Grenville St, Toronto M5S1B2, Canada; tim.dwyer{at}


Acute compartment syndrome (ACS) is a potentially reversible orthopedic surgical emergency leading to tissue ischemia and ultimately cell death. Diagnosis of ACS can be challenging, as neither clinical symptoms nor signs are sufficiently sensitive. The cardinal symptom associated with ACS is pain reported in excess of what would otherwise be expected for the underlying injury, and not reasonably managed by opioid-based analgesia. Regional anesthesia (RA) techniques are traditionally discouraged in clinical settings where the development of ACS is a concern as sensory and motor nerve blockade may mask symptoms and signs of ACS. This Education article addresses the most common trauma and elective orthopedic surgical procedures in adults with a view towards assessing their respective risk of ACS and offering suggestions regarding the suitability of RA for each type of surgery.

  • anesthesia
  • conduction
  • nerve block
  • regional anesthesia

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  • Funding AN receives research time support from the Fracture Care Research Endowed Chair, St Michael’s Hospital, Toronto, Ontario, Canada. RB receives research time support from the Evelyn Bateman Cara Operations Endowed Chair in Ambulatory Anesthesia and Women’s Health, Women’s College Hospital, and Merit Award Program, Department of Anesthesia and Pain Medicine, Toronto, Ontario, Canada.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.