Case Reports
Vol. 3 No. 1 (2025)
https://doi.org/10.4081/aapm.49.

Gluteal acute compartment syndrome in a patient undergoing neuraxial anesthesia: a case report

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Published: 21 August 2025
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Compartment syndrome, neuraxial, pain

Authors

Ilaria Piccione
ilariapiccione95@gmail.com
Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Italy.
Giovanni D'Agostino
Department of Anesthesiology and Critical Care, San Giuliano Hospital, Giugliano (NA), Italy.
Fabio Marinelli
Department of Anesthesiology and Critical Care, San Giuliano Hospital, Giugliano (NA), Italy.
Dario Cirillo
Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Italy.
Antonio Coviello
Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples “Federico II”, Italy.

Acute compartment syndrome (ACS) is defined as increased pressure within a muscle fascial compartment. The incidence of ACS is higher in individuals with multiple risks. The current diagnosis of ACS is based on clinical findings and intramuscular pressure (IMP). The patient in our case report is a man with a complex medical history undergoing lower limb orthopedic surgery. A combined spinal-epidural anesthetic was administered without complications. Postoperative pain management was carried out with continuous epidural infusion. Three boluses of 10 mL 0.2% ropivacaine via the epidural catheter were required due to postoperative pain (VAS 9/10), partially reducing the localized pain in the gluteal region (VAS 7/10). Clinical monitoring revealed swelling and redness in the gluteal region. Fasciotomy was avoided due to spontaneous symptom resolution. Diagnosing ACS is rarely straightforward and requires a high index of suspicion and clinical awareness. Our study demonstrates that epidural anesthesia has contributed to accelerating the diagnostic process.

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1. Tiwari A, Haq AI, Myint F, Hamilton G. Acute compartment syndromes. Br J Surg 2002;89:397-412. DOI: https://doi.org/10.1046/j.0007-1323.2002.02063.x
2. Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Adv Orthop 2015;2015:543412. DOI: https://doi.org/10.1155/2015/543412
3. Adib F, Posner AD, O’Hara NN, O’Toole RN. Gluteal compartment syndrome: A systematic review and Meta-Analysis. Injury 2022;53:1209-17 DOI: https://doi.org/10.1016/j.injury.2021.09.019
4. Agius C, Cole E. Acute compartment syndrome (ACS) - a case of delayed diagnosis. Int J Orthop Trauma Nurs 2021;42:100845. DOI: https://doi.org/10.1016/j.ijotn.2021.100845
5. Shadgan B, Pereira G, Menon M, et al. Risk factors for acute compartment syndrome of the leg associated with tibial diaphyseal fractures in adults. J Orthop Traumatol 2015;16:185-92. DOI: https://doi.org/10.1007/s10195-014-0330-y
6. Rorabeck CH. The treatment of compartment syndromes of the leg. J Bone Joint Surg 1984;66:94-7. DOI: https://doi.org/10.1302/0301-620X.66B1.6693486
7. Coviello A, Iacovazzo C, Cirillo D, et al. Tetra-block: ultrasound femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks in lower limb anesthesia: a case series. J Med Case Rep 2023;17:270. DOI: https://doi.org/10.1186/s13256-023-04017-6
8. Coviello A, Ianniello M, Buonanno P, et al. Effects of depth of neuromuscular block on surgical operating conditions in women undergoing gynecologic laparoscopic surgery: a randomized clinical trial. J Anesth Analg Crit Care 2023;3:2. DOI: https://doi.org/10.1186/s44158-023-00086-7
9. Hilber N, Dodi A, Blumenthal S, et al. The impact of regional anesthesia in masking acute compartment syndrome after limb trauma. J Clin Med 2024;13:1787. DOI: https://doi.org/10.3390/jcm13061787
10. Tran AA, Lee D, Fassihi SC, et al. A systematic review of the effect of regional anesthesia on diagnosis and management of acute compartment syndrome in long bone fractures. Eur J Trauma Emerg Surg 2020;46:1281-90. DOI: https://doi.org/10.1007/s00068-020-01320-5
11. Mubarak SJ, Hargens AR, Owen CA, et al. The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am 1976;58:1016-20. DOI: https://doi.org/10.2106/00004623-197658070-00022
12. Matsen FA, Winquist RA, Krugmire RB Jr. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am 1980;62:286-91. DOI: https://doi.org/10.2106/00004623-198062020-00016

How to Cite



Gluteal acute compartment syndrome in a patient undergoing neuraxial anesthesia: a case report. (2025). Advances in Anesthesia and Pain Medicine, 3(1). https://doi.org/10.4081/aapm.49.
Copyright (c) 2025 Ilaria Piccione, Giovanni D'Agostino, Fabio Marinelli, Dario Cirillo, Antonio Coviello Creative Commons License

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