Relationship Between Perioperative Regional Anesthesia and the Risk of Missing Acute Compartment Syndrome Following Tibia Fractures
Authors' conclusion
The results do not provide evidence that perioperative regional anesthesia increases the incidence of missed ACS in patients with operative tibial shaft or plateau injuries. but does decrease postoperative opioid requirements.
Study context
- Population
- Adults with operative tibial shaft or plateau fractures, January 2015–April 2022, minimum 3-month follow-up
- Participants
- 791 adults
- Exposure
- Peripheral nerve block vs no nerve block
- Nerve blockn = 610
- No nerve blockn = 176reference
- Outcome
- Missed ACS (postinjury motor deficit still present at the 3-month postoperative appointment)
- Follow-up
- 3 months
Methodological detailsretrospective chart review, single-centre, level-one trauma hospital
- Retrospective chart review
- Single-centre
- Level-one trauma hospital
Main finding
As reported in the abstract
Missed ACS
P = 0.19
- Overall incidence of missed acute compartment syndrome (ACS)
- 0.9% (7/791, 95% CI, 0.4%-1.8%)
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| MME consumed 24 h after surgery · lower MME with nerve block | P < 0.001 |
ACS diagnosed and treated during index hospitalization
- Incidence
- 2.2% (17/791, 95% CI, 1.3%-3.4%)
Missed ACS by block type (nerve block subgroup)
- All patients with missed ACS who received a nerve block (n = 4) received a perineural catheter
Missed ACS by fracture type (tibial shaft vs plateau)
- Similar missed ACS rates between tibial shaft and plateau fractures
Original publication
Relationship Between Perioperative Regional Anesthesia and the Risk of Missing Acute Compartment Syndrome Following Tibia Fractures. Anesth Analg. Published 28 June 2024. doi:10.
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