title: Did continuous femoral and sciatic nerve block obscure the diagnosis or delay the treatment of acute lower leg compartment syndrome? A case report.
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.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  Report of a clinical case.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Division of Acute Pain Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA. mcometa@anest.ufl.edu
authors.forename: M Anthony
authors.initials: MA
authors.lastname: Cometa
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Esch
authors.forename: André P
authors.initials: AP
authors.lastname: Boezaart
mesh_terms: D000293:Adolescent; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000628:therapy*; D005267:Femoral Nerve / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D007866:Leg / Q000294:innervation* / Q000473:pathology*; D008297:Male; D009407:Nerve Block / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D000077212:Ropivacaine; D012584:Sciatic Nerve / Q000187:drug effects* / Q000503:physiopathology
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine