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Compartment Syndrome  

 

 

Background​

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  • Fascial membranes in the human body combine to surround muscle groups in the human body

  • Compartment syndrome: increased pressure in fascial compartments compromises circulation and function of tissue within these compartments

    • Positive feedback:  ischemia —> necrosis —> edema —> further increase in compartment pressure

  • Epidemiology:

    • Occurs most commonly after trauma, esp long bone #

    • Incidence 7.3/100k in men and 0.7/100k in women

    • Most common sites are the:

      • Fibular and extensor compartments in lower leg

      • Extensor compartment in forearm

  • Risk factors:

    • Sustained fracture or soft-tissue injury

      • Tibial diaphyseal, distal radius & diaphyseal forearm #’s 

    • ↑ Age

    • ↑ Comminuted #

    • High-energy mechanism

 

 

Considerations 

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  • Have a ↑ degree of suspicion in at-risk patients

  • 3 P’s (low sensitivity to & high specificity):

    • Pain - main clinical sign, classically pain "out of proportion" to injury

    • Paresthesia - late clinical sign

    • Paresis - even later clinical sign

  • Diagnosis:

    1. Clinical signs/symptoms (3 P’s)

    2. Measure compartment pressure, where normal compartment pressure ~ 8mmHg

    3. Calculate Critical Δ Tissue pressure = Diastolic BP - compartment pressure

      • > 30mmHg = normal

      • < 30mmHg = indication for fasciotomy (100% sens & 100% specif)

  • Achieve adequate pain control with the lowest possible dose 

    • In effort to avoid delayed diagnosis of compartment syndrome

  • Sudden increase in pain should be compartment syndrome until proven otherwise

  • Avoid epidurals in patients at ↑ risk

    • Theoretical, ↑ risk of delayed diagnosis of compartment syndrome

    • If using epidural, use low-concentration solution

  • Peripheral regional anesthesia is safe & does not delay diagnosis of compartment syndrome

    • But opt to use dilute concentrations & minimal adequate dose

  • Liberal indication for fasciotomy

 

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References 

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  • Marhofer P, Halm J, Feigl GC, Schepers T, Hollmann MW. Regional Anesthesia and Compartment Syndrome. Anesth Analg. 2021 Nov 1;133(5):1348-1352. doi: 10.1213/ANE.0000000000005661. PMID: 34255752.

 

 

 

 

 

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