26 de abril de 2013

Artigo recomendado: Case Scenario - Compartment Syndrome of the Forearm in Patient with an Infraclavicular Catheter


Breakthrough Pain as Indicator

José A. Aguirre, Daniela Gresch, Annemarie Popovici, Jost Bernhard, Alain Borgeat

Anesthesiology 2013; 118:1198-205, Aguirre et al.

Acute compartment syndrome (ACS) represents a limb-threatening condition. Delaying diagnosis and therapy may lead to irreversible neuromuscular ischemic damages with subsequent functional deficits.1 Diagnosis is primarily clinical and characterized by a pain level that quality exceeds the clinical situation. Diagnosis is assessed by invasive pressure monitoring within the suspected compartment. Once ACS has been confirmed it represents a surgical emergency with definitive treatment requiring immediate fasciotomy to relieve the pressure within the affected compartment. Irreversible tissue damage can occur within 4–6 h after the onset of symptoms. However, nerves are already seriously damaged after 2h of increased compartment pressure. Concerns about masking pain as cardinal symptom and therefore leading to a delay in diagnosis and therapy have been raised in connection with regional anesthesia. Moreover, several case reports and case series have blamed different types of regional anesthesia and even the use of opioid patient-controlled analgesia for delaying diagnosis of ACS. Therefore, the use of regional anesthesia for trauma and orthopedic surgery remains controversial. A case involving continuous regional anesthesia of the upper extremity and the development of an ACS is presented.

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