Acute Pain Control Challenges with Buprenorphine/Naloxone Therapy in a Patient with Compartment Syndrome Secondary to McArdle's Disease: A Case Report and Review

We report the first case of non?iatrogentic exertional rhabdomyolysis leading to acute compartment syndrome in a patient with McArdle’s disease. We describe considerations of concurrent buprenorphine/naloxone therapy during episodes of severe acute pain.
DesignCase report.
Case PresentationA 50?year?old male with a history of McArdle’s disease, taking buprenorphine/naloxone for chronic pain and opioid dependence, presented to the Emergency Department with severe bilateral anterior thigh pain. Over the following 8 hours, he was given a total of 12?mg of intravenous hydromorphone with minimal pain relief. The decision was made to initiate patient?controlled analgesia (PCA) with hydromorphone started at 0.5?mg as needed with a 15?minute lockout. Subsequently, the patient’s anter…