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Diagnostic peripheral nerve block resulting in compartment syndrome. Case report
J R Parziale1, A R Marino, J H Herndon
1Dept. of Orthopaedics and Rehabilitation, Rhode Island Hospital, Providence 02903.
American Journal of Physical Medicine & Rehabilitation
|April 1, 1988
Summary
A rare case of forearm compartment syndrome occurred after a peripheral nerve block for spasticity in a hemiplegic patient. Anticoagulation may heighten bleeding risks, necessitating prompt recognition and treatment.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Peripheral nerve blocks are used to manage spasticity post-cerebrovascular accident.
- Anticoagulation is often prescribed for cerebrovascular disease prophylaxis.
Observation:
- A hemiplegic patient on anticoagulation developed volar forearm compartment syndrome within 48 hours of a median nerve block.
- This complication has not been previously associated with nerve block procedures.
Findings:
- Compartment syndrome is a potential complication of peripheral nerve blocks for spasticity.
- Prophylactic anticoagulation may increase the risk of hemorrhagic complications from percutaneous injections.
- Early diagnosis and surgical decompression are crucial for managing post-nerve block compartment syndrome.
Implications:
- Clinicians should consider compartment syndrome in patients presenting with forearm pain and swelling after nerve blocks, especially those on anticoagulation.
- This case highlights the importance of careful patient selection and monitoring during nerve block procedures in anticoagulated individuals.
- Prompt surgical intervention, such as decompressive fasciotomy, may be necessary to prevent irreversible tissue damage.