Postsurgical compartment syndrome of the forearm diagnosed in a child receiving a continuous infra-clavicular peripheral nerve block.

Opinions diverge as to whether or not regional anaesthesia delays the diagnosis of evolving acute compartment syndrome. Withholding regional anaesthesia from patients with painful orthopaedic injuries may be ethically unacceptable, however. In this report, we describe a case of acute compartment syndrome in a 4-year old child who underwent resection of a forearm osteochondroma. Analgesia was satisfactory during the first post-operative night, but the child later complained of pain despite an effective infra-clavicular block. Motor function and sensibility were disturbed and the fingers were swollen. The forearm cast was removed as it was suspected to be causing external compression. Pain disappeared while motor function and sensation recovered. The child was discharged without any complications. Despite an effective peripheral nerve block and the young age of the patient, the diagnosis of acute compartment syndrome could be made thanks to a well-defined post-operative analgesia protocol, a high level of suspicion and careful clinical assessment when break-through pain occurred.