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The Journal of Bone and Joint Surgery 79:1271-2 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Michael L. Schmitz, M.D., Raeford E. Brown Jr., M.D., JoAnne M. Stoner, M.D., J. Michael Vollers, M.D., Charles T. Price, M.D., John Ribeiro, M.D. and Todd Kinnebrew, M.D.

TO THE EDITOR:

Price et al., in "Compartment Syndromes Associated with Postoperative Epidural Analgesia. A Case Report" (78-A: 597–599, April 1996), reported on a sixteen-year-old boy with hypophosphatemic rickets in whom a compartment syndrome developed after bilateral corrective osteotomy. Price et al. believed that the epidural analgesia masked the symptoms of the compartment syndrome. We believe that this conclusion is in error for the following reasons. First, the postoperative pain was treated with an epidural infusion of fentanyl. The authors, however, did not report either the dosage utilized for the infusion or the size of the patient. Second, drugs that may alter sympathetic tone or blood flow to the extremity, or both, when given in the epidural space were mentioned in the Discussion; however, none of the drugs mentioned are pharmacologically similar to fentanyl. Finally, it was suggested that fentanyl may act more like meperidine than morphine to produce alterations . . . [Full Text of this Article]


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