Year Book: Compartment Syndrome: A Complication of Intravenous

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Regional Anesthesia in the Reduction of Lower Leg Shaft Fractures. Maletis-GB. Watson-RC. Scott-S. 1990 Year Book of Orthopedics. Article 2-35. Orthopedics. 1989 Jun. 12. pp 841-846. Compartment syndrome is a known complication of lower leg fractures. It has been suggested that applying a tourniquet above a fracture site sets up a condition of ischemia in an area that is already a prime target for compartment syndrome, and that intravenous (IV) regional anesthesia compounds the situation and increases the chances of compartment syndrome. The incidence of compartment syndrome after IV regional anesthesia for the reduction of a lower leg fracture was compared with that in a control group of patients who underwent general anesthesia or IV analgesia alone. The study included 41 patients who underwent closed reduction of displaced lower leg shaft fractures under IV regional anesthesia and 39 patients who underwent reduction of lower leg shaft fractures under IV analgesia or general anesthesia. After operation, 4 of the 41 patients who underwent closed reduction under regional anesthesia were graded as having mild compartment syndrome, 2 had moderate cases, and 5 had severe cases, yielding a 27% overall incidence rate of compartment syndrome. Of the 39 control patients, 3 were graded as having mild compartment syndrome and 2 were graded as severe, yielding an overall compartment syndrome incidence rate of 13%. Because acceptable alternative methods of pain control are available, it is suggested that IV regional anesthesia not be used in the management of lower leg shaft fractures.