Regional Analgesia and Acute Compartment Syndrome

This narrative review discusses the differing opinions regarding whether and when regional analgesia can be utilized to treat injury and surgical pain when there is a high risk for acute compartment syndrome. The pathophysiology and objective means for early identification of acute compartment syndrome are reviewed. The mechanism of how regional anesthesia affects nociceptive and ischemia pain is reviewed, along with new proposed theories for why and when it may not block ischemic pain associated with acute compartment syndrome. Implications for a practical approach to regional analgesics in patients at risk for acute compartment syndrome are presented. Regional analgesia offers excellent site-specific pain relief with minimal to no systemic side effects. Understanding acute compartment syndrome pathophysiology and when modified regional analgesia techniques can potentially identify early diagnosis may improve pain management and reduce associated complications in these patients.