Regional Anesthesia & Pain Medicine has just published a research paper (available online ahead of print) co-authored by several colleagues in the UF Department of Anesthesiology examining the incidence of acute compartment syndrome (ACS) while using regional anesthesia for pain management in patients with long bone fractures.
Because of concerns that diagnosing ACS in these patients could be hindered when peripheral nerve blocks (PNBs) are employed, their use has been limited. The article’s retrospective review of 26,537 patients over a ten-year period examines the occurrence of ACS in these patients, with the authors finding “a relatively low incidence despite the routine use of PNBs under strictly protocolized conditions when patients were managed by a dedicated multidisciplinary care team.”
Svetlana Chembrovich, M.D., assistant professor of anesthesiology, was the lead author for the article. Other co-authors from the Department of Anesthesiology included:
- Barys V. Ihnatsenka, M.D., associate professor of anesthesiology
- Cameron R. Smith, M.D., Ph.D., associate professor of anesthesiology
- Yury Zasimovich, M.D., associate professor anesthesiology and chief of the Acute Pain Medicine Division
- Amy Gunnett, R.N., BSN, manager of the Clinical Research Office
- Linda Le-Wendling, M.D., professor of anesthesiology and director of the Regional Anesthesiology & Acute Pain Medicine Fellowship Program
Timothy Petersen, Ph.D., research assistant professor in the Department of Anesthesiology and Critical Care Medicine at the University of New Mexico, also contributed as a co-author.
While guidance regarding the use of PNBs in patients at risk of ACS has relied on practitioner experience and anecdotal case presentations, this study represents the significant contribution of a decade’s worth of patient data from a level I tertiary academic institution to the issue.
“The conscientious use of PNBs for pain management of long bone fractures with avoidance of high concentration and dose of local anesthetics resulting in less-dense blocks may provide good analgesia with the symptoms of ACS not being masked and thus allow for timely ACS diagnosis,” stated Chembrovich and her colleagues.
This study will benefit future research by providing a wealth of data for future researchers and clinical registries to help develop new tools and methods for assessing and managing these patients. Still, the authors noted that “at the level of our current knowledge and technology, close vigilance and a high index of suspicion remain the hallmarks of early diagnosis and treatment of ACS of any cause, not only long bone fractures.”
Congratulations to Dr. Chembrovich and her co-authors!