Bilateral compartment syndrome complicating prolonged lithotomy position

Area of Science:

• Anesthesiology
• Surgical Complications
• Orthopedics

Background:

• Prolonged lithotomy position, particularly the Lloyd-Davies variant, is associated with potential complications.
• Compartment syndrome is a surgical emergency characterized by increased pressure within a fascial compartment.
• Effective analgesia does not preclude the development of compartment syndrome.

Observation:

• A case of bilateral compartment syndrome occurred after a prolonged Lloyd-Davies lithotomy procedure.
• The diagnosis was established early, despite the use of extradural bupivacaine-fentanyl for pain management.
• The clinical presentation and diagnostic challenges are detailed.

Findings:

• Compartment syndrome can arise from prolonged extreme positioning during surgery.
• Early recognition and intervention are critical to prevent severe sequelae.
• The pathophysiology, diagnostic methods, and treatment options for compartment syndrome are reviewed.

Implications:

• Anesthesiologists must be vigilant for positional complications in unconscious patients.
• Awareness of potential risks associated with surgical positioning is essential for patient safety.
• Prompt management of compartment syndrome can mitigate life-threatening and permanently disabling outcomes.