Abstract

Purpose

The purpose of this study was to determine if increased milligram morphine equivalent (MME) requirements are a predictor of adult compartment syndrome in patients with tibia fractures.

Methods

A retrospective case-control study at a level-1 trauma center was performed over a five year period. Patients with tibia fractures who had acute compartment syndrome (ACS) requiring fasciotomy (n = 26) were matched with controls (n = 25). MME and pain scores were assessed within the 24 hour period preceding fasciotomy (cases) or fixation (controls). The presence or absence of the “6 Ps” and other clinical signs (diastolic blood pressure [DBP]) were also analyzed.

Results

Mean MMEs two hours before surgery was 25.5 ± 39.2 for ACS patients versus 8.6 ± 11.1 in controls (P = 0.043), while the mean pain scores were 8.8 ± 1.8 and 7.0 ± 2.5 (P = 0.049), respectively. Multivariable regression showed patients with ACS consumed 16.9 MME more than controls within two hours of surgery (P = 0.043) and scored 1.8 points higher on the numeric pain rating scale (P = 0.049). The mean number of clinical signs of compartment syndrome in the ACS patients was 3.4 ± 1.3 compared to 0.84 ± 0.85 in controls (P < 0.001). DBP was significantly higher in ACS patients within two to four hours of surgery (P = 0.005).

Conclusion

Increased MME requirements and pain scores within two hours of surgery were significant predictors of ACS following tibia fracture. Increased narcotic requirements, pain scores, and DBP may be useful objective indicators of evolving ACS, in addition to the traditional signs, and should be closely monitored in the at-risk patient.

中文翻译：

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吗啡需求量的增加可预测成年胫骨骨折的急性室综合征。

摘要

目的

这项研究的目的是确定是否增加毫克吗啡当量（MME）的需求量可预测胫骨骨折患者的成人室综合征。

方法

在一级创伤中心进行了为期五年的回顾性病例对照研究。需要进行筋膜切开术的急性间隔综合征（ACS）的胫骨骨折患者（n  = 26）与对照组（n  = 25）相匹配。在筋膜切开术（病例）或固定术（对照组）之前的24小时内评估MME和疼痛评分。还分析了是否存在“ 6 Ps”和其他临床体征（舒张压[DBP]）。

结果

ACS患者术前两小时的平均MME为25.5±39.2，而对照组为8.6±11.1（P  = 0.043），而平均疼痛评分分别为8.8±1.8和7.0±2.5（P  = 0.049）。多变量回归显示，ACS患者在手术后两小时内比对照组多消耗16.9 MME（P  = 0.043），并且在数字疼痛评分量表上得分高1.8点（P  = 0.049）。ACS患者车厢综合征的平均临床体征为3.4±1.3，而对照组为0.84±0.85（P  <0.001）。在手术后两到四个小时内，ACS患者的DBP显着升高（P  = 0.005）。

结论

MME需求增加和手术两小时内的疼痛评分是胫骨骨折后ACS的重要预测指标。除传统体征外，增加的麻醉药需求，疼痛评分和DBP可能是演变为ACS的有用客观指标，应对处于危险中的患者进行密切监测。