Impact of Regional Anesthesia on the Incidence and Detection of Acute Compartment Syndrome: A Systematic Review.

Abstract

Background: Acute compartment syndrome (ACS) is a limb-threatening complication of orthopedic trauma, and the use of regional anesthesia (RA) remains controversial due to concerns that it may delay diagnosis. This systematic review evaluated whether RA influences the incidence or detection of ACS and whether current evidence supports its use in orthopedic trauma patients.

Materials and methods: PubMed, Embase, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched from inception through January 21, 2026. Two reviewers independently screened studies and extracted data. Randomized controlled trials, prospective studies, and retrospective comparative studies evaluating orthopedic trauma patients receiving RA versus non-RA techniques were included. Study quality was assessed using the Methodological Index for Non-randomized Studies and the Newcastle-Ottawa Scale. Owing to methodological heterogeneity, findings were synthesized narratively.

Results: Of 1,429 records identified, 185 were screened for title and abstract, 58 full-text articles were assessed, and 5 studies (1 randomized controlled trial and 4 retrospective cohorts) involving 105,139 patients met inclusion criteria. Most studies evaluated spinal or peripheral nerve blocks for long-bone fractures. ACS incidence among patients receiving RA ranged from 0% to 0.1%, with no study demonstrating an increased risk of ACS or delayed diagnosis compared with general anesthesia. Several studies reported reduced perioperative opioid consumption with RA, although functional outcomes were inconsistently reported.

Conclusion: Current evidence does not demonstrate that RA increases ACS incidence or delays its recognition in orthopedic trauma patients. RA appears to be a reasonable analgesic option when combined with standardized postoperative monitoring and a high index of clinical suspicion.