Did Continuous Femoral and Sciatic Nerve Block Obscure the Diagnosis or Delay the Treatment of Acute Lower Leg Compartment Syndrome? A Case Report

Authors

  • M. Anthony Cometa MD,

    Corresponding author
    1. Department of Anesthesiology, Division of Acute Pain Medicine
      M. Anthony Cometa, MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA. Tel: 352-265-0077; Fax: 352-265-8013; E-mail: mcometa@anest.ufl.edu.
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  • Andrea T. Esch DO,

    1. Department of Anesthesiology, Division of Acute Pain Medicine
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  • André P. Boezaart MD, PhD

    1. Department of Anesthesiology, Division of Acute Pain Medicine
    2. Department of Orthopedic Surgery and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida, USA
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  • Presentations: None.

  • Financial Support: None.

M. Anthony Cometa, MD, Department of Anesthesiology, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL 32610, USA. Tel: 352-265-0077; Fax: 352-265-8013; E-mail: mcometa@anest.ufl.edu.

Abstract

Objective.  We report a case of acute lower extremity compartment syndrome that was diagnosed despite continuous regional analgesia with 0.2% ropivacaine via femoral and sciatic nerve catheters.

Setting.  Academic tertiary care center.

Study Design.  Report of a clinical case.

Summary.  A 15-year-old boy with adolescent Blount's disease underwent elective distal femur and proximal tibia osteotomy with external fixation and stabilization of his right leg. The patient's anesthetic and analgesic management included general anesthesia with adjunctive regional anesthesia via continuous femoral and sciatic nerve blocks with 0.2% ropivacaine—each block initially infused at 10 mL per hour. On the first postoperative day, the patient reported no pain (0/10 on the visual analog scale, where 0 is no pain and 10 is the worst pain imaginable). However, on the second postoperative day, the patient reported severe pain despite effective blocks and oral opioid analgesic modalities. Compartment syndrome was diagnosed and treated with decompressive fasciotomy; tissue loss resulted.

Conclusion.  Despite concerns of masking pain that may be secondary to compartment syndrome, this case demonstrates that compartment syndrome can be diagnosed in the presence of effective regional anesthesia. Careful clinical evaluation coupled with a high index of suspicion is essential in the timely diagnosis and effective treatment of compartment syndrome.

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