Regional anesthesia or patient-controlled analgesia and compartment syndrome in orthopedic surgical procedures: a systematic review

Elizabeth BS Driscoll,1 Ana Hosseinzadeh Maleki,2 Leila Jahromi,3 Brittany Nelson Hermecz,4 Lauren E Nelson,5 Imelda L Vetter,6 Spencer Evenhuis,2 Lee Ann Riesenberg2 1Department of Anesthesiology, University of Tennessee, Knoxville, TN, 2Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, Birmingham, AL, 3Department of Biology, Georgia State University, Atlanta, GA, 4Department of Diagnostic Radiology, University of Alabama at Birmingham School of Medicine, Birmingham, 5University of South Alabama College of Medicine, Mobile, 6School of Health Professions, Lister Hill Library, University of Alabama at Birmingham, Birmingham, AL, USA Abstract: A systematic review of the literature on the use of regional anesthesia (RA) and patient-controlled analgesia (PCA) was conducted in patients who require orthopedic extremity procedures to determine whether either analgesic technique contributes to a delayed diagnosis of compartment syndrome (CS). A total of 34 relevant articles (28 case reports and six research articles) were identified. Of all case report articles published after 2009, the majority (75%) concluded that RA does not put the patient at an increased risk of a delayed diagnosis of CS. Of these, only two relevant prospective research studies focusing on RA or PCA and their relationship to CS were identified. Neither study resulted in any cases of CS. However, both had relatively small sample sizes. Given the lack of evidence identified in this systematic review, prospective studies or large-scale retrospective data reviews are needed to more strongly advocate the use of one modality of analgesia over the other in this patient population. Keywords: compartment syndrome, patient-controlled analgesia, regional anesthesia, peripheral nerve bloc