In the Journals

Compartment syndrome after opioid overdose linked with poor functional recovery

Eric Swart

Patients who were found unconscious after an opiate overdose and had crush injuries that led to compartment syndrome experienced high surgical complication rates and poor recovery of function, according to published results.

Eric Swart , MD, and colleagues performed a retrospective review of 30 patients who were managed with either fasciotomy or observation for compartment syndrome following a crush injury from a prolonged period of unconsciousness after an opiate overdose. Researchers categorized patients into partial deficit, complete deficit or unexaminable groups based on presentation, and compared operative findings, hospital course, laboratory values and functional status among the groups.

Of the 25 patients managed with fasciotomy, results showed an average of 4.2 operations were required. Researchers also found a 20% infection rate and a 12% amputation rate among the fasciotomy group. Despite being elevated, lactate, creatine phosphokinase and creatinine levels did not correspond with muscle viability or return to function, according to results.

Researchers noted 56% of patients had muscle that appeared nonviable at the time of initial debridement. However, results showed 28% of patients who had questionable viability had muscle function return. On initial examination, researchers found four patients had no motor or neurological function, and none had meaningful return of function at the time of the latest follow-up. Some improvement in ultimate function was found in 70% of 10 patients who had partial neurological deficits at the time of presentation and underwent fasciotomy, according to results.

“In short, this study shows that surgery (fasciotomy) on patients ‘found down’ from opiate overdose has a high complication rate and relatively poor recovery of function,” Swart told Healio.com/Orthopedics. “As a result, the risk/benefit ratio of fasciotomy in this clinical setting is likely different than for patients with acute traumatic syndrome, and treatment decisions should be made with this in mind.” – by Casey Tingle

 

Disclosures: Swart reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.

Eric Swart

Patients who were found unconscious after an opiate overdose and had crush injuries that led to compartment syndrome experienced high surgical complication rates and poor recovery of function, according to published results.

Eric Swart , MD, and colleagues performed a retrospective review of 30 patients who were managed with either fasciotomy or observation for compartment syndrome following a crush injury from a prolonged period of unconsciousness after an opiate overdose. Researchers categorized patients into partial deficit, complete deficit or unexaminable groups based on presentation, and compared operative findings, hospital course, laboratory values and functional status among the groups.

Of the 25 patients managed with fasciotomy, results showed an average of 4.2 operations were required. Researchers also found a 20% infection rate and a 12% amputation rate among the fasciotomy group. Despite being elevated, lactate, creatine phosphokinase and creatinine levels did not correspond with muscle viability or return to function, according to results.

Researchers noted 56% of patients had muscle that appeared nonviable at the time of initial debridement. However, results showed 28% of patients who had questionable viability had muscle function return. On initial examination, researchers found four patients had no motor or neurological function, and none had meaningful return of function at the time of the latest follow-up. Some improvement in ultimate function was found in 70% of 10 patients who had partial neurological deficits at the time of presentation and underwent fasciotomy, according to results.

“In short, this study shows that surgery (fasciotomy) on patients ‘found down’ from opiate overdose has a high complication rate and relatively poor recovery of function,” Swart told Healio.com/Orthopedics. “As a result, the risk/benefit ratio of fasciotomy in this clinical setting is likely different than for patients with acute traumatic syndrome, and treatment decisions should be made with this in mind.” – by Casey Tingle

 

Disclosures: Swart reports no relevant financial disclosures. Please see the study for a list of all other authors’ relevant financial disclosures.

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