Acute compartment syndrome and regional anaesthesia - a case report

We describe the case of an adult 19 year old male with a fractured right radius. The patient underwent a revision open reduction and internal fixation due to mal-alignment under combined general anaesthesia and supraclavicular brachial plexus block. Postoperatively the patient developed disproportionately intense pain despite an otherwise fully functioning sensory and motor block. The limb was swollen, tender and there was loss of radial pulse. Upon re-exploration a large haematoma was evacuated, a bleeding vessel being the causative factor. There were no further sequellae. The hallmark of this case report is the presence of out-of-proportion pain with an odd distribution in the forearm in the presence of a dense and fully established nerve block. Acute compartment syndrome was diagnosed based on classical signs and symptoms within two hours of block performance. Appropriate treatment lead to satisfactory outcome.