Compartment syndrome following intravenous regional anesthesia

Purpose: To present two cases of upper extremity compartment syndrome follo wing intravenous regional anesthesia, Clinical features: Case 1: A 57-yr-old man presented for surgical release o f a left-hand Dupuytren's contracture. The procedure was performed under iv regional anesthesia with 360 mg lidocaine and sedation with 150 mug fentan yl and 1.5 mg midazolam, Tourniquet time was 107 min at a pressure of 260 m mHg using three different tourniquet sites. Within minutes of tourniquet re lease, increased forearm muscle tension, hand anesthesia, pallor, and limit ed motor function developed, Serum CK and myoglobin levels rose. Myoglobinu ria was present. Several fasciotomies and aggressive fluid therapy were per formed, Patient made almost full recovery. Case 2: A 73-yr-old woman with c ontrolled hypertension had Dupuytren fasciotomy of her right hand under iv regional anesthesia with 200 mg lidocaine and sedation using 75 mug fentany l and 1.5 mg midazolam, Tourniquet time was 64 min at a pressure of 250 mmH g using three different tourniquet sites. The patient complained of pain at the iv site during injection of local anesthetic, third tourniquet inflati on and after deflation of tourniquet. Thirty minutes after arrival in PACU, her fingers were bluish. She complained of pain and swelling of the forear m, Under general anesthesia, fasciectomy was performed. Myoglobin and CPK l evels rose, CPK MB was high but troponin was negative, Three days later she developed pulmonary embolism. She was heparinized and subsequently dischar ged home, She recovered completely, Conclusion: Compartment syndrome may have a rapid and severe onset. Etiolog y of our cases is still not established. We postulate that increased tissue pressure may be the cause. The anesthesiologists must be aware of compartm ent syndrome during regional anesthesia.