Compartment syndrome after prolonged lithotomy position in patient receiving combined epidural and general anesthesia

Iwasaka, Hideo; Itoh, Kouji; Miyakawa, Hiroshi; Noguchi, Takayuki; Kitano, Takaaki; Taniguchi, Kazuo; Honda, Natsuo

doi:10.1007/s0054030070468

Cited by 4 publications

(2 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Twelve cases of compartment syndrome associated with epidural analgesia in patients less than 18-yearold were identified from eight papers (3,(5)(6)(7)(8)(9)(10)(11).…”

Section: Resultsmentioning

confidence: 99%

Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children?

Johnson

Chalkiadis

2009

Pediatric Anesthesia

View full text Add to dashboard Cite

One of the cardinal symptoms of compartment syndrome is pain. A literature review was undertaken in order to assess the association of epidural analgesia and compartment syndrome in children, whether epidural analgesia delays the diagnosis, and to identify patients who might be at risk. Evidence was sought to offer recommendations in the use of epidural analgesia in patients at risk of developing compartment syndrome of the lower limb. Increasing analgesic use, increasing/breakthrough pain and pain remote to the surgical site were identified as important early warning signs of impending compartment syndrome in the lower limb of a child with a working epidural. The presence of any should trigger immediate examination of the painful site, and active management of the situation (we have proposed one clinical pathway). Avoidance of dense sensory or motor block and unnecessary sensory blockade of areas remote to the surgical site allows full assessment of the child and may prevent any delay in diagnosis of compartment syndrome. Focusing on excluding the diagnosis of compartment syndrome rather than failure of analgesic modality is vital. In the pediatric cases reviewed there was no clear evidence that the presence of an epidural had delayed the diagnosis.

show abstract

“…Twelve cases of compartment syndrome associated with epidural analgesia in patients less than 18-yearold were identified from eight papers (3,(5)(6)(7)(8)(9)(10)(11).…”

Section: Resultsmentioning

confidence: 99%

Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children?

Johnson

Chalkiadis

2009

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…Actually, PCA and continuous EDA might mask the symptoms of acute compartment syndrome [ 4 , 16 , 19 , 20 , 21 , 22 , 23 , 24 , 31 ]. In fact, single shot epidural or single shot spinal anesthesia have not been associated with ACS [ 14 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma

Hilber,

Dodi,

Blumenthal

et al. 2024

JCM

View full text Add to dashboard Cite

Regional anesthesia has shown to be successful in controlling major pain in trauma patients. However, the possibility of masking acute compartment syndrome (ACS) after peripheral nerve blocks for limb injuries is still controversially discussed. Therefore, we aimed to summarize the current literature regarding this topic to shed light on the impact of peripheral regional anesthesia on the diagnosis of ACS in trauma patients. We searched Pubmed, Google Scholar and the Cochrane Library for literature following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The analysis of these reports was included in the context of the current literature concerning this topic. We found no (randomized) studies, and only six case reports dealing with the impact of peripheral nerve blocks and ACS in patients after a limb trauma met our criteria and were included in our review. Only one reported a delay in the diagnosis of ACS. In most of the cases (5 of 6), the breakthrough pain, despite the nerve block, proved to be a good indicator of a developing ACS. However, despite some narrative articles about the topic including some recommendations about the possibly safe use of regional anesthesia techniques for limb trauma, there is still no international consensus and only one national guideline focusing on the possibly safe use of peripheral nerve blocks in trauma patients at risk of ACS. After reviewing the respective literature, we consider that intra-articular analgesia, sensory blocks, fascial plane blocks and low-concentration continuous peripheral nerve blocks are effective for analgesia and a low-risk analgesia tool for trauma and postsurgical patients at risk of ACS due to the fact that they do not lead to a dense block. Finally, we summarized suggestions based on the results of the literature for the different regional anesthesia modalities in these patients in a table to facilitate the use of these techniques.

show abstract

Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis

Mar

Barrington

Mcguirk

2009

British Journal of Anaesthesia

155

View full text Add to dashboard Cite

Acute compartment syndrome can cause significant disability if not treated early, but the diagnosis is challenging. This systematic review examines whether modern acute pain management techniques contribute to delayed diagnosis. A total of 28 case reports and case series were identified which referred to the influence of analgesic technique on the diagnosis of compartment syndrome, of which 23 discussed epidural analgesia. In 32 of 35 patients, classic signs and symptoms of compartment syndrome were present in the presence of epidural analgesia, including 18 patients with documented breakthrough pain. There were no randomized controlled trials or outcome-based comparative trials available to include in the review. Pain is often described as the cardinal symptom of compartment syndrome, but many authors consider it unreliable. Physical examination is also unreliable for diagnosis. There is no convincing evidence that patient-controlled analgesia opioids or regional analgesia delay the diagnosis of compartment syndrome provided patients are adequately monitored. Regardless of the type of analgesia used, a high index of clinical suspicion, ongoing assessment of patients, and compartment pressure measurement are essential for early diagnosis.

show abstract

Compartment syndrome after prolonged lithotomy position in patient receiving combined epidural and general anesthesia

Cited by 4 publications

References 8 publications

Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children?

Does epidural analgesia delay the diagnosis of lower limb compartment syndrome in children?

The Impact of Regional Anesthesia in Masking Acute Compartment Syndrome after Limb Trauma

Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis

Contact Info

Product

Resources

About