Abstract
Acute compartment syndrome (ACS) arises from increased pressure within a confined osteofascial compartment, leading to tissue ischemia, metabolic deficits, and potential irreversible damage if untreated. Although trauma is the most common cause, obesity-especially when combined with immobility-can increase the risk of ACS, presenting significant challenges in anesthetic management. This case report details the anesthesiological management of a 42-year-old man with severe obesity (BMI 78 kg/m²), classified as super-super obese, who presented with ACS in his right lower limb. Given his complex airway and the limitations of performing general anesthesia (GA), a regional anesthetic approach was selected. Due to anatomical challenges posed by the patient's obesity, an adductor canal block was performed using ultrasound and Doppler guidance to identify key structures and achieve a successful block. The patient was sedated, remained hemodynamically stable during surgery, and required minimal analgesics postoperatively. This case highlights the critical role of regional anesthesia in super obese patients, overcoming challenges like difficult anatomical landmarks and limited equipment, and underscores the importance of personalized, adaptive approaches to achieve optimal outcomes. Despite the technical difficulties, this successful use of regional anesthesia provides valuable insights into the management of high-risk super obese patients with ACS and reinforces the need for anesthesiologists to employ creative and flexible techniques, including advanced imaging tools, to ensure safe anesthesia care.