Torrie Arissa, Sharma Jyoti, Mason Mark, Cruz Eng Hillenn
Department of Internal Medicine, Penn State Health, Hershey, PA, USA.
Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA.
Am J Case Rep. 2017 Apr 24;18:444-447. doi: 10.12659/ajcr.902708.
BACKGROUND Acute compartment syndrome (ACS) of the thigh after elective primary total knee arthroplasty is rare. If not recognized and treated promptly, devastating consequences may result. Certain regional anesthesia techniques are thought to mask the symptoms of acute compartment syndrome, but there are no cases reported of adductor canal catheters masking the symptoms of thigh compartment syndrome. We report a case where symptoms and diagnosis of acute anterior thigh compartment syndrome were not masked by a functioning adductor canal catheter. CASE REPORT A 56-year-old male developed anterior thigh compartment syndrome after an elective primary total knee arthroplasty. Surgery was performed under spinal anesthesia with periarticular local infiltration analgesia. Postoperatively, an adductor canal catheter was placed, atraumatically, under ultrasound guidance in the recovery room with a plan to begin a continuous infusion of 0.2% ropivacaine 10 hours after the periarticular injection. Six hours after surgery, the patient complained of tightness and 10/10 pain in his right thigh, which was initially managed with parenteral opioids with moderate success. Continuous infusion through the adductor canal catheter was started and pain improved to 6/10 aching pain. Nonetheless, two hours after starting the continuous infusion, the patient reported tightness, swelling, and 10/10 pressure-like pain that was not relieved by the peripheral catheter infusion or PRN boluses of additional opioids. Due to the patient's symptomatology compartment pressures were measured. The anterior compartment pressure was 47 mm Hg and emergent anterior compartment fasciotomy was performed. CONCLUSIONS In this case, a functioning adductor canal catheter did not mask symptoms of, or delay diagnosis of, acute compartment syndrome in the thigh.
择期初次全膝关节置换术后大腿急性骨筋膜室综合征（ACS）较为罕见。若未及时识别和治疗，可能会导致严重后果。某些区域麻醉技术被认为会掩盖急性骨筋膜室综合征的症状，但尚无关于收肌管导管掩盖大腿骨筋膜室综合征症状的病例报道。我们报告一例功能正常的收肌管导管未掩盖大腿前侧急性骨筋膜室综合征症状及诊断的病例。病例报告：一名56岁男性在择期初次全膝关节置换术后发生大腿前侧骨筋膜室综合征。手术在脊麻联合关节周围局部浸润镇痛下进行。术后，在超声引导下于恢复室无创置入收肌管导管，计划在关节周围注射10小时后开始持续输注0.2%罗哌卡因。术后6小时，患者主诉右大腿紧绷及疼痛评分10分，最初采用胃肠外阿片类药物治疗，有一定效果。通过收肌管导管开始持续输注，疼痛改善至疼痛评分6分。然而，在开始持续输注两小时后，患者报告紧绷、肿胀及疼痛评分10分的压迫样疼痛，外周导管输注或额外按需推注阿片类药物均无法缓解。鉴于患者的症状，测量了骨筋膜室内压力。前侧骨筋膜室内压力为47 mmHg，遂急诊行前侧骨筋膜室切开减压术。结论：在本病例中，功能正常的收肌管导管未掩盖大腿急性骨筋膜室综合征的症状，也未延迟其诊断。
