A 72-year-old woman, ASA physical status II, weighing 47 kg, with
uterine cancer was scheduled for semiradical
hysterectomy. She had uncontrolled
diabetes mellitus with FBS 123 mg x dl(-1) and HbA1c 7.0%. After an epidural
catheter had been placed at the L1-2 level,
general anesthesia was induced with
propofol 100 mg,
fentanyl 50 microg and
vecuronium 5 mg. The trachea was intubated, and ventilation was controlled.
Anesthesia was maintained with 1.5%
sevoflurane in 30%
oxygen and
epidural anesthesia. Systolic blood pressure was maintained between 80-120 mmHg throughout the operation and the total blood loss was 1260 g. Continuous
epidural anesthesia was started 1 hour before the end of operation using 0.2%
ropivacaine and 3.7 microg x ml(-1)
fentanyl at 5 ml x hr(-1). She awoke in the operating room and her trachea was extubated. After awaking from
anesthesia, she complained of weakness and
numbness in the both lower extremities. We considered these as an influence of epidurally administered 5 ml of 0.5%
ropivacaine 30 min before the end of surgery. However, 2 hours later, she complained of right lower leg
pain. We removed the epidural
catheter, considering the possibility of the epidural
catheter tip stimulating nerve root. However, next morning, the frontal part of her right lower leg turned reddish and swollen, and the
pain appeared with the pulse of dorsalis pedis artery hardly palpable. Taken together these symptoms and the elevation of
creatine kinase to 20000 IU x l(-1), we diagnosed as a
compartment syndrome. In the evening of the postoperative one day, emergent
fasciotomy was performed under
local anesthesia. She was discharged with full recovery of her right leg function, and a well healed
fasciotomy scar. Magnetic resonance angiography (MRA) on the 10th postoperative day demonstrated the obstruction of the right superficial femoral artery and anterior tibial artery. Emergent
fasciotomy is the recommended treatment for severe
compartment syndrome. Early recognition, diagnosis, and surgical intervention averted potential neural and functional impairment in this patient.