Sonawane Kartik, Dhamotharan Preethi, Dixit Hrudini, Gurumoorthi Palanichamy
Anesthesiology, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, IND.
Anesthesiology and Perioperative Medicine, Ganga Medical Centre and Hospitals Pvt. Ltd., Coimbatore, IND.
Cureus. 2022 Oct 27;14(10):e30776. doi: 10.7759/cureus.30776. eCollection 2022 Oct.
Pain management in trauma or surgery with a high risk of developing compartment syndrome (CS) is always challenging due to fears of masking symptoms that could delay diagnosis and treatment. Regional anesthesia/analgesia (RA) can facilitate enhanced postoperative recovery and improve patient satisfaction by providing excellent postoperative analgesia. However, its consideration in surgeries with a high risk of developing CS remains controversial and contentious. Studies suggest focusing more on early diagnosis through regular vigilant monitoring with a high index of suspicion rather than discontinuing the analgesic method alone. The most consistent features in all reported cases of CS were altered sensation in the affected limb, disproportionate pain in the presence of a functional nerve block, and an escalating need for analgesics. Several extrinsic or intrinsic factors are responsible for the progressive increase in compartment pressure that can lead to vascular compromise and subsequent ischemic changes in muscles, tissues, and nerves. Measurement of intracompartmental pressure (ICP) has always been considered the gold standard for diagnosing CS. An ICP of 30 mm Hg is considered the cut-off point for fasciotomy that helps restore muscle perfusion and avoid irreversible tissue damage. The chronology of symptoms can sometimes provide clues to the severity of CS, the pathophysiology involved, and the management required. Therefore, it is necessary to look for warning signs, further investigate the causes, and make quick decisions to diagnose and treat CS and its complications on time. Any delay in the diagnosis and treatment of CS can result in high morbidity and poor outcomes. A well-integrated interprofessional team of health professionals can deliver the required complexity of care through a holistic and multidisciplinary approach. This review article highlights the symptoms, risk factors, and pathophysiology involved in CS. It can guide readers in choosing various options to diagnose, prevent, and treat CS. It also discusses the role of RA in patients or surgeries prone to developing CS.
对于存在发生骨筋膜室综合征（CS）高风险的创伤或手术患者，疼痛管理一直具有挑战性，因为担心掩盖症状会延误诊断和治疗。区域麻醉/镇痛（RA）通过提供出色的术后镇痛效果，有助于促进术后恢复并提高患者满意度。然而，在存在发生CS高风险的手术中考虑使用RA仍存在争议。研究表明，应更注重通过高度怀疑的定期警惕监测进行早期诊断，而不是仅停止镇痛方法。在所有报告的CS病例中，最一致的特征是患肢感觉改变、在功能性神经阻滞存在时疼痛不成比例以及对镇痛药的需求不断增加。几个外在或内在因素导致骨筋膜室内压力逐渐升高，这可能导致血管受压以及随后肌肉、组织和神经的缺血性改变。骨筋膜室内压力（ICP）的测量一直被认为是诊断CS的金标准。30 mmHg的ICP被认为是筋膜切开术的临界点，有助于恢复肌肉灌注并避免不可逆的组织损伤。症状的时间顺序有时可以为CS的严重程度、所涉及的病理生理学以及所需的管理提供线索。因此，有必要寻找警示信号，进一步调查原因，并迅速做出决策，以便及时诊断和治疗CS及其并发症。CS诊断和治疗的任何延迟都可能导致高发病率和不良后果。一个整合良好的跨专业医疗团队可以通过全面和多学科的方法提供所需的复杂护理。这篇综述文章强调了CS所涉及的症状、危险因素和病理生理学。它可以指导读者选择诊断、预防和治疗CS的各种方法。它还讨论了RA在易发生CS的患者或手术中的作用。
