Klucka Jozef, Stourac Petr, Stouracova Alena, Masek Michal, Repko Martin
Department of Paediatric Anaesthesiology and Intensive Care Medicine, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic.
Department of Radiology, Faculty of Medicine, Masaryk University and University Hospital Brno, Jihlavska 20, 625 00 Brno, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2017 Sep;161(3):242-251. doi: 10.5507/bp.2017.025. Epub 2017 May 24.
Acute compartment syndrome (ACS) is a potential orthopaedic/traumatology emergency. Without prompt, precise diagnosis and immediate treatment with surgical decompressive fasciotomy it can lead to neurological dysfunction and disability. The role of regional anaesthesia (RA) in patients at risk for ACS/ and in those with developed ACS is controversial. The aim of this critical review was to answer the question, whether regional anaesthesia can delay the diagnosis. The authors use an evidence-based approach to discuss these high risk patients in considering RA as a method of choice for effective analgesia. To the date of data collection, there was no single case report identified where RA alone led to delay in ACS diagnosis and surgical treatment. In four clinical cases, epidural analgesia can be associated with delayed ACS diagnosis. Frequent clinical evaluation and breakthrough pain despite a functional RA in combination with intracompartment pressure measurement remains the keystone of recommended management for patients at risk of ACS.
急性筋膜室综合征（ACS）是一种潜在的骨科/创伤科急症。若不及时、准确诊断并立即进行手术减压筋膜切开术治疗，可能会导致神经功能障碍和残疾。区域麻醉（RA）在ACS高危患者以及已发生ACS的患者中的作用存在争议。这篇批判性综述的目的是回答区域麻醉是否会延迟诊断这一问题。作者采用循证方法，在将RA视为有效镇痛的一种选择方法时，对这些高危患者进行讨论。截至数据收集之日，尚未发现有单独因RA导致ACS诊断和手术治疗延迟的病例报告。在4例临床病例中，硬膜外镇痛可能与ACS诊断延迟有关。对于ACS高危患者，频繁的临床评估以及尽管有有效的RA但仍出现的突破性疼痛，结合筋膜室内压力测量，仍然是推荐治疗的关键。
