The clinical diagnosis of an acute compartment syndrome is most reliably based on increasing pain and pain on stretching the affected muscle groups. These signs cannot be elicited in the presence of epidural or regional blocks, or if the patient is unconscious. We present a national audit of consultant trauma and orthopaedic surgeons on the use of compartmental pressure monitoring in such patients. The postal questionnaire also asked whether a departmental protocol was in use and whether regional and epidural blocks were withheld in patients at risk of developing an acute compartment syndrome.

17% of consultants had such an agreed protocol, 53% did not have access to a continuous pressure monitoring device, 58% would request for an epidural/regional block to be withheld with only 2% routinely measuring compartment pressures in the presence of such a block.

This study highlights a major deficiency in the clinical approach to a relatively common condition that may result in limb and life threatening complications and supports the recommendation for compartmental monitoring equipment to be made available.