Acute postoperative compartment syndrome in a child receiving patient-controlled analgesia and peripheral nerve block

Acute postoperative compartment syndrome in a child receiving patient-controlled analgesia and peripheral nerve block

Published: 08 Jun 2018

© Anaesthesia Cases / 2018-0072 / ISSN 2396-8397

Authors

Dr Sarah Ryan [1]
Dr Patrick Wiseman [2]
Dr Stephen Mannion [3]
Dr Michael O'Sullivan [3]
  • [1] Specialist Registrar, Anaesthesia, South infirmary and Victoria university hospital, Cork, Ireland
  • [2] Registrar, Anaesthesia, Coombe Women and Infants University Hospital, Dublin, Ireland
  • [3] Consultant, Anaesthesia, South Infirmary Victoria University Hospital, Cork, Ireland

Summary

Patient-controlled analgesia and nerve blocks have been implicated in the delayed or missed diagnosis of acute compartment syndrome. We report a case of early successful diagnosis of acute compartment syndrome in a 15-year-old male, who received both morphine-based patient-controlled analgesia and a femoral nerve block following corrective surgery for patellofemoral instability. Our case demonstrates that multimodal analgesia, combining both patient-controlled analgesia and a nerve block, does not necessarily prevent the early diagnosis of an evolving compartment syndrome. There must be a high level of clinical awareness amongst medical and nursing staff regarding the serious potential complication of postoperative compartment syndrome and ongoing vigilance to monitor for its symptoms and signs.

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