Regional Anesthesia Did Not Delay Diagnosis of Compartment Syndrome: A Case Report of Anterior Compartment Syndrome in the Thigh Not Masked by an Adductor Canal Catheter

Patient: Male, 56 Final Diagnosis: Anterior compartment syndrome of the thigh Symptoms: Unrelenting pain on the anterior aspect of the right thigh Medication: Morphine • Lyrica • Flexeril • Percocet 5/325 • Hydromorphone • Synthroid • Metformin Clinical Procedure: Adductor canal catheter placement, emergent fasciotomy Specialty: Anesthesiology OBJECTIVE: Unusual clinical course BACKGROUND: Acute compartment syndrome (ACS) of the thigh after elective primary total knee arthroplasty is rare. If not recognized and treated promptly, devastating consequences may result. Certain regional anesthesia techniques are thought to mask the symptoms of acute compartment syndrome, but there are no cases reported of adductor canal catheters masking the symptoms of thigh compartment syndrome. We report a case where symptoms and diagnosis of acute anterior thigh compartment syndrome were not masked by a functioning adductor canal catheter. CASE REPORT: A 56-year-old male developed anterior thigh compartment syndrome after an elective primary total knee arthroplasty. Surgery was performed under spinal anesthesia with periarticular local infiltration analgesia. Postoperatively, an adductor canal catheter was placed, atraumatically, under ultrasound guidance in the recovery room with a plan to begin a continuous infusion of 0.2% ropivacaine 10 hours after the periarticular injection. Six hours after surgery, the patient complained of tightness and 10/10 pain in his right thigh, which was initially managed with parenteral opioids with moderate success. Continuous infusion through the adductor canal catheter was started and pain improved to 6/10 aching pain. Nonetheless, two hours after starting the continuous infusion, the patient reported tightness, swelling, and 10/10 pressure-like pain that was not relieved by the peripheral catheter infusion or PRN boluses of additional opioids. Due to the patient’s symptomatology compartment pressures were measured. The anterior compartment pressure was 47 mm Hg and emergent anterior compartment fasciotomy was performed. CONCLUSIONS: In this case, a functioning adductor canal catheter did not mask symptoms of, or delay diagnosis of, acute compartment syndrome in the thigh.