Acute compartment syndrome (ACS) is a severe condition characterized by increased pressure within a closed fascial compartment, compromising circulation and tissue viability. The cardinal symptom of ACS is severe, disproportionate pain, often exacerbated by passive muscle stretch. Additional symptoms include paraesthesia, muscle weakness, and tense swelling, while pulselessness is a late and unreliable sign. Diagnosis relies on clinical suspicion and compartment pressure monitoring, with a threshold of ≥30 mmHg indicating the need for urgent intervention. Pathophysiology involves increased intracompartmental pressure, which leads to reduced tissue perfusion, cellular hypoxia, and potential muscle necrosis. Surgical decompression via fasciotomy is the primary treatment, with delayed intervention resulting in permanent disability, amputation, or systemic complications. The role of regional anaesthesia in ACS remains controversial, as it may mask pain and delay diagnosis, though careful monitoring can mitigate risks. This article underscores the importance of early recognition and timely surgical management to prevent irreversible complications associated with ACS.