Bilateral compartment syndrome following prolonged anaesthesia in the lithotomy position

Can J Anaesth 1997; 44: 678-679.
To the Editor: A 29-year-old man underwent a five hour urological surgical procedure in the lithotomy position for posterior urethral stricture repair. No hypotension was observed during anaesthesia. The patient complained of bilateral calf pain with swollen tense extremities at the end of surgery. High levels of CPK, LDH, AST, ALT and oliguria were reported on the first postoperative day. ACT scan revealed a wide, hypodense area of the soleus and lateral head of gastrocnemius muscles in both lower limbs. Doppler examination excluded arterial or venous occlusion and confirmed bilateral compartment syndrome. A conservative management approach was adopted: m lower extremities were positioned at heart level, analgesic and myorelaxant drugs were used to control pain and contracture of both calves and sodium bicarbonate and crystaUoids were administered to prevent acute renal failure. The patient was discharged on the 17th postoperative day without neurological sequelae and all laboratory findings were normal. Compartment syndromes result from many factors: fight leg bindings, direct pressure on calves and prolonged time in the lithotomy position, s but the syndrome may also occur following surgical procedure of as little as five hours duration in the lithotomy position. Treatment of the syndrome is controversial: some advise early fasciotomy s-s and others recommend conservative treatment. Compartment syndrome may be prevented avoiding any unnecessary compression points of the lower extremities; pulse oximeters on both feet are recommended and prolonged hypotension must be avoided.