Compartment Syndrome in Tibial Shaft Fracture Missed Because of a Local Nerve Block

Acute compartment syndrome risk in fracture fixation with regional blocks

“…Hyder et al ,11 identified a patient who was given a nerve block for intramedullary nailing of a tibial fracture. The patient reported increasing pain in the leg but compartment pressures were not measured until 48 h postprocedure, by which time they were found to be significantly elevated; the patient underwent emergency fasciotomy.…”

Pain Control in Acute Trauma

“…In these patients, the option of regional anesthesia should be thoroughly discussed with the surgical team. Despite the concern of regional anesthesia masking compartment syndrome, there are actually very few reported cases of this occurring [69,70]. Llewellyn et al reported a series of over 10,000 pediatric patients with epidural analgesia.…”

“…Other reports of compartment syndrome in the presence of regional block describe cases in which diagnosis may or may not have been delayed [71][72][73]. One report blamed the delayed diagnosis of an anterior lower leg compartment syndrome on the presence of a femoral nerve block even though a femoral block would not at all affect sensation in the affected area [70]. It is likely that the paucity of reports of regional anesthesia masking compartment syndrome is primarily due to the avoidance of regional anesthesia in patients with predisposing injuries.…”

Compartment Syndrome of the Lower Extremity

“…Additionally, specific anesthesiological procedures (local nerve blocks, epidural anesthesia, and other forms of intra-and postoperative regional anesthesia) may hamper clinical evaluation [83][84][85]. The use of local anesthetics combined with narcotics during epidural anesthesia has been shown to increase the likelihood of missed compartment syndromes and is not recommended in the at risk patient [86][87][88].…”