Regional anesthesia and acute compartment syndrome: principles for practice

Area of Science:

• Orthopedic Surgery
• Anesthesiology
• Emergency Medicine

Background:

• Acute compartment syndrome (ACS) is a critical orthopedic emergency causing tissue ischemia.
• Diagnosing ACS is challenging due to non-specific clinical signs and symptoms.
• Regional anesthesia (RA) is often avoided in ACS-risk scenarios as it can mask key indicators.

Purpose of the Study:

• To evaluate the risk of ACS in common adult orthopedic procedures.
• To determine the suitability of RA for orthopedic surgeries with varying ACS risks.
• To provide guidance on RA use in the context of potential ACS.

Main Methods:

• Review of common trauma and elective orthopedic surgical procedures in adults.
• Assessment of the inherent risk of ACS for each procedure.
• Analysis of how RA techniques might obscure ACS diagnosis.

Main Results:

• Certain orthopedic procedures carry a higher risk of ACS development.
• RA can potentially mask the cardinal symptom of disproportionate pain in ACS.
• The suitability of RA varies significantly based on the specific surgical procedure and ACS risk.

Conclusions:

• Careful consideration of ACS risk is essential when planning RA for orthopedic surgery.
• RA may be safely employed in lower-risk procedures, but caution is advised in high-risk cases.
• This article provides a framework for assessing RA suitability to avoid masking ACS.