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Postsurgical compartment syndrome of the forearm diagnosed in a child receiving a continuous infra-clavicular

L Sermeus, S Boeckx, H Camerlynck

    Acta Anaesthesiologica Belgica
    |June 25, 2015
    PubMed

    Insights

    Regional anesthesia may not delay acute compartment syndrome diagnosis. Careful clinical assessment and protocols are key for early detection, even in young patients with effective nerve blocks.

    Area of Science:

    • Orthopaedic Surgery
    • Pain Management
    • Paediatric Care

    Background:

    • Regional anesthesia is debated for its potential to mask acute compartment syndrome (ACS).
    • Withholding regional anesthesia for painful orthopedic injuries raises ethical concerns.
    • This case examines ACS diagnosis in a pediatric patient receiving regional anesthesia.

    Observation:

    • A 4-year-old child developed ACS post-forearm osteochondroma resection despite an effective infra-clavicular block.
    • Break-through pain, motor/sensory deficits, and finger swelling indicated ACS.
    • Removing the constrictive forearm cast resolved symptoms.

    Findings:

    • Early ACS diagnosis is possible with vigilant monitoring and established pain management protocols.
    • Effective peripheral nerve blocks do not preclude ACS diagnosis.
    • Clinical suspicion and assessment are crucial for identifying ACS, even in young patients.

    Implications:

    • Supports the judicious use of regional anesthesia in pediatric orthopedic surgery.
    • Highlights the importance of comprehensive post-operative care protocols for early ACS detection.
    • Emphasizes that clinical acumen remains paramount in diagnosing emergent conditions like ACS.

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