Regional Anaesthesia for Tibial Fracture Surgery in the Third Trimester of Pregnancy

Abstract

Presentation
A 27-year-old woman at 33 weeks’ gestation presented with severe pain and swelling in her lower leg following a fall from a standing height at home.

Diagnosis
Imaging confirmed a severely comminuted tibial fracture. Given pregnancy-related concerns and historical debate regarding peripheral nerve blockade masking acute compartment syndrome (ACS), careful perioperative planning was undertaken with multidisciplinary input.

Treatment
The patient elected for regional anaesthesia following shared decision-making. Intraoperative anaesthesia was achieved with a single-shot spinal and popliteal sciatic nerve block. Postoperative analgesia included a continuous low-concentration sciatic catheter infusion, intravenous paracetamol, and PRN oxycodone, alongside structured neurovascular monitoring.

Discussion
This case demonstrates that regional anaesthesia with low-dose continuous peripheral nerve blockade can provide effective analgesia in tibial trauma during pregnancy without delaying ACS recognition when rigorous monitoring is employed, while also minimizing foetal exposure to systemic anaesthesia and opioids.