title: Differences in attitudes to analgesia in post-operative limb surgery put patients at risk of compartment syndrome.
abstract: Missed compartment syndrome may result in severe disability. Complete masking of pain, the cardinal symptom of compartment syndrome, may contribute to delayed or missed diagnosis. Scenarios reported in the literature as cases of delayed or missed compartment syndrome (due to analgesia) were included in a questionnaire. Each of the respondents was requested to indicate the preferred choice of post-operative analgesia for each scenario. Significant differences were found between orthopaedic surgeons and anaesthetists regarding the preferred choice of post-operative analgesia in clinical situations which have been previously shown to be associated with a high risk of compartment syndrome. Use of analgesic methods which impair the ability to detect patients with abnormal levels of pain or unusual demands for analgesia may place such patients at risk of the devastating sequelae of a missed compartment syndrome. The differences in attitudes to local and regional nerve blockade between orthopaedic surgeons and anaesthetists suggests that some anaesthetists may be exposing patients to the risk of missed compartment syndrome following extremity surgery.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Hull Royal Infirmary, Anlaby Road, Kingston-upon-Hull HU3 2JZ, UK. thonser@hotmail.com
authors.forename: Raghuram
authors.initials: R
authors.lastname: Thonse
authors.forename: Robert U
authors.initials: RU
authors.lastname: Ashford
authors.forename: T Ian R
authors.initials: TI
authors.lastname: Williams
authors.forename: Paul
authors.initials: P
authors.lastname: Harrington
mesh_terms: D000698:Analgesia / Q000009:adverse effects / Q000523:psychology*; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000209:etiology; D003951:Diagnostic Errors; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008505:Medical Staff, Hospital / Q000592:standards; D010149:Postoperative Pain / Q000517:prevention & control*; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology; D011364:Professional Practice; D012307:Risk Factors; D011795:Surveys and Questionnaires