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

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.