Bedside fasciotomy under local anesthesia for acute compartment syndrome: a feasible and reliable procedure in selected cases

Abstract

BackgroundFasciotomy for compartment syndrome is an emergent procedure that is usually done in the operating theater under general anesthesia. Delay in performing the procedure can lead to worse outcome. Various reasons can cause delay in performing the surgery. Bedside fasciotomy under local anesthesia can be done in these cases to avoid delay in compartment release.Materials and methodsThis was a retrospective study of 34 cases of acute compartment syndrome for which fasciotomy was done at the bedside under local anesthesia. The minimum follow-up period was 6 months.ResultsAll patients had immediate and marked improvement in pain. Thirty-three patients regained their normal muscle strength. Thirty-two patients regained normal range of motion of adjacent joints. One patient developed flexion contracture of the great toe. There was no deep infection, chronic osteomyelitis, or amputation. Superficial wound infection was noted in three patients; one patient had persistent foot drop.ConclusionBedside fasciotomy under local anesthesia is a feasible, safe, and effective choice for treating compartment syndrome in patients with delayed presentation or those with anticipated delay to undergo surgery in the operating theater under general or regional anesthesia. The results of this study are encouraging, as all wounds healed satisfactory and there were no cases of deep infections. The formal release of compartments in the operating room under general anesthesia continues to be the standard of care. This is the first description in the literature for bedside fasciotomy under local anesthesia with a relatively large number of patients.

Profile of Hand Compartment Syndrome in Dr. Hasan Sadikin General Hospital, West Java, 2008−2012

“…7,11 In this study, not all of the patients underwent fasciotomy promptly. As explained by Ebraheim et al 12 , the compartment syndrome should be diagnosed and treated as fast as possible. This is important to prevent progression of syndrome and prevent complications.…”

A pilot study of surgical telementoring for leg fasciotomy

“…In addition, we did not address clinical diagnosis, pressure measurement, anaesthesia and perioperative care. Bedside fasciotomy under local anaesthesia and sedation may be an option when resources are limited 25. Finally, the connection consisted of a solid local Wi-Fi network, which may not be representative of field conditions.…”

Compartment Syndrome Following Total Knee Arthroplasty: Clinical Results of Late Fasciotomy

“…Generally, it has been known that fasciotomy within 6 to 8 hours after the onset of symptoms could result in a good prognosis2,3,4,5). Little or no return of function can be expected if diagnosis and treatment are delayed3).…”