• M Anthony Cometa, Andrea T Esch, and André P Boezaart.
• Department of Anesthesiology, Division of Acute Pain Medicine, University of Florida College of Medicine, Gainesville, Florida 32610, USA. mcometa@anest.ufl.edu
• Pain Med. 2011 May 1;12(5):823-8.

ObjectiveWe 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.SettingAcademic tertiary care center.Study DesignReport of a clinical case.SummaryA 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.ConclusionDespite 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.Wiley Periodicals, Inc.

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