Department of Anaesthesia, Nottingham University Hospitals NHS Trust, President, Association of Anaesthetists (Co-Chair), Nottingham, UK.
Imperial College, Vice President, Royal College of Anaesthetists (Co-Chair), London, UK.
Anaesthesia. 2021 Nov;76(11):1518-1525. doi: 10.1111/anae.15504. Epub 2021 Jun 6.
Pain resulting from lower leg injuries and consequent surgery can be severe. There is a range of opinion on the use of regional analgesia and its capacity to obscure the symptoms and signs of acute compartment syndrome. We offer a multi-professional, consensus opinion based on an objective review of case reports and case series. The available literature suggested that the use of neuraxial or peripheral regional techniques that result in dense blocks of long duration that significantly exceed the duration of surgery should be avoided. The literature review also suggested that single-shot or continuous peripheral nerve blocks using lower concentrations of local anaesthetic drugs without adjuncts are not associated with delays in diagnosis provided post-injury and postoperative surveillance is appropriate and effective. Post-injury and postoperative ward observations and surveillance should be able to identify the signs and symptoms of acute compartment syndrome. These observations should be made at set frequencies by healthcare staff trained in the pathology and recognition of acute compartment syndrome. The use of objective scoring charts is recommended by the Working Party. Where possible, patients at risk of acute compartment syndrome should be given a full explanation of the choice of analgesic techniques and should provide verbal consent to their chosen technique, which should be documented. Although the patient has the right to refuse any form of treatment, such as the analgesic technique offered or the surgical procedure proposed, neither the surgeon nor the anaesthetist has the right to veto a treatment recommended by the other.
小腿损伤及随后手术引起的疼痛可能很严重。对于使用区域镇痛及其掩盖急性间隔综合征的症状和体征的能力，存在各种意见。我们提供了一种多专业的共识意见，该意见基于对病例报告和病例系列的客观审查。现有文献表明，应避免使用导致长时间密集阻滞且显著超过手术持续时间的脊神经或外周区域技术。文献回顾还表明，单次或连续使用低浓度局部麻醉药物且无辅助药物的外周神经阻滞不会导致诊断延迟，只要损伤后和术后的监测适当且有效。损伤后和术后病房观察和监测应能识别急性间隔综合征的体征和症状。这些观察应由接受过急性间隔综合征病理和识别培训的医护人员按规定频率进行。在可能的情况下，应向有发生急性间隔综合征风险的患者充分解释镇痛技术的选择，并应获得其选择的技术的口头同意，并记录在案。尽管患者有权拒绝任何形式的治疗，如提供的镇痛技术或拟议的手术，但外科医生和麻醉师均无权否决另一方推荐的治疗。
