Compartment Syndrome and Regional Block — FRCA Final MCQ

Correct answer: B — A low-concentration local anaesthetic infusion without adjuncts may be used if effective surveillance and a multidisciplinary protocol are maintained

Explanation lettering: C = shown as A · D = shown as C · A = shown as D

B is correct. Current RCoA guidance states that low-concentration single-shot or continuous peripheral nerve blocks without adjuncts have not been associated with delayed diagnosis of acute compartment syndrome when surveillance is appropriate and effective. Regional analgesia is therefore not absolutely contraindicated after tibial trauma. Dense, prolonged blocks should be avoided because they may impede assessment; breakthrough pain is concerning but is not a sufficiently reliable diagnostic test to justify such a block. Serial assessment by trained staff and rapid escalation within a multidisciplinary protocol remain essential. Pressure measurement supplements assessment when the diagnosis is uncertain but does not replace surveillance. New or escalating pain must trigger urgent reassessment for compartment syndrome rather than an automatic catheter bolus, which could delay recognition and treatment.

Reference: Royal College of Anaesthetists. Guidelines for the Provision of Regional Anaesthesia Services 2025, section 8.26: Trauma and Orthopaedics. https://rcoa.ac.uk/gpas/chapter-8