A patient suffered a post-partum haemorrhage in recovery following an elective caesarean section and was taken back to theatre for insertion of an intra-uterine balloon and vaginal pack. Post-operatively, the patient developed compartment syndrome in the left arm, requiring fasciotomies. The blood pressure cuff, ID band, and cannula were removed from the affected arm, which was elevated. The patient was unable to care for newborn twins independently and reported high pain scores.

Commentary

Compartment syndrome of the arm is a rare event but can arise if intravenous fluid extravasates during volume resuscitation, particularly when using a pressure bag¹.  This is a limb-threatening condition, causing nerve palsies that requires prompt treatment with fasciotomy.

Reference

1. Willsey D, Peterfreund R. Compartment Syndrome of the Upper Arm after Pressurised Infiltration of Intravenous Fluid. J Clin Anesth.1997; 9:428-430