Compartment syndrome associated with bupivacaine and fentanyl epidural analgesia in pediatric orthopaedics

Two patients had a compartment syndrome after surgery at a remote site performed under a continuous lumbar infusion of a mixture of narcotic (fentanyl) and local anesthetic (bupivacaine 0.1%). Each patient had inadvertent excessive pressure applied to the limb distally and had no perception of pain in the presence of this analgesic combination. After the relief of this pressure from a sling or traction apparatus, each child had signs of a compartment syndrome, and this sensation of pathologic pain was not masked by the epidural infusion. A discussion of the literature questions the benefits of bupivacaine local anesthetic as a routine addition to epidural analgesia for orthopaedic surgery.