Purpose:The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field.However,many complications following the use of tourniquets have been reported.Tourniquet pain is th...Purpose:The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field.However,many complications following the use of tourniquets have been reported.Tourniquet pain is the most common complication.This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors.Methods:It is a prospective observational study conducted on 132 consecutive cases.Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study.Patients with open injuries or contraindications such as diabetes mellitus,compromised circulatory states,neurological deficit,compartment syndrome and unable to give informed consent were excluded.The parameters assessed included duration of tourniquet use,tourniquet pressure,type of anesthesia,any interval release of the tourniquet and reapplication after a reperfusion period,whether upper or lower limb surgery,severity of tourniquet pain,timing of tourniquet release and complications.Chi-square and non-parametric Mann-Whitney U test were used for data analysis.Results:In upper limb surgeries,if duration of surgery was less than 60 min,14(51.8%)cases experienced tourniquet pain and 13(48.1%)had no pain,and if duration of surgery was more than 60 min,24(60.0%)had pain and 16(40.0%)experienced no pain.In lower limb surgeries if duration of surgery was less than 60 min,2(7.7%)experienced pain and 24(92.3%)had no pain,and if duration of surgery was more than 60 min,14(35.8%)experienced pain and 25(64.8%)had no pain.Degree of tourniquet pain increases with the duration of surgery.Statistically,there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs(p=0.034 and 0.024,respectively)Conclusion:Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia.Other risk factors assessed including tourniquet pressure,upper or lower limb surgery,tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.展开更多
Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleteri...Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoral-sciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation.展开更多
目的止血带在全膝关节置换术中的应用一直存在争议。文中探讨全膝关节置换术中不同止血带压力对于患肢术后疼痛肿胀的影响,并对损伤机制进行初步分析。方法选取2017年6月-12月于南京总医院行全膝关节置换术的患者96例,按照随机数字表法...目的止血带在全膝关节置换术中的应用一直存在争议。文中探讨全膝关节置换术中不同止血带压力对于患肢术后疼痛肿胀的影响,并对损伤机制进行初步分析。方法选取2017年6月-12月于南京总医院行全膝关节置换术的患者96例,按照随机数字表法将患者分为240 mm Hg(低压力)组、270 mm Hg(中压力)组和300 mm Hg(高压力)组,对患者术前及术后1~2 d的疼痛及大腿周径进行测量;同时分别于术前及术后3、8、24 h抽取血标本检测过氧化物歧化酶1(SOD1)、前列腺素E2(PGE2)、肌红蛋白,并进行比较。结果术后第1天与第2天内,低压力组与中压力组患肢疼痛差异无统计学意义(P>0.05);低压力组、中压力组与高压力组之间比较,差异均有统计学意义(P<0.05),且低压力组更加明显(P<0.01)。术后第1天与第2天内,低压力组与中压力组患者大腿周径比较差异无统计学意义(P>0.05);低压力组、中压力组与高压力组比较,差异均有统计学意义(P<0.05)。相关分析结果显示,压力与疼痛(r=0.518,P<0.01)与肿胀(r=0.345,P<0.05)均呈正相关。术后3 h内,3组在SOD1和PGE2水平差异均有统计学意义(P<0.05);在术后8 h及24 h时,低压力组与中压力组在SOD1和PGE2水平上差异无统计学意义(P>0.05);仅高压力组分别与中压力组和低压力组之间差异有统计学意义(P<0.05)。而肌红蛋白在术后3 h时,低压力组与中压力组差异无统计学意义(P>0.05)。高压力组分别与中压力组、低压力组肌红蛋白水平差异有统计学意义(P<0.05)。在术后8 h及24 h,3组之间在肌红蛋白水平上差异均有统计学意义(P<0.05)。结论患肢术后疼痛、肿胀与术中止血带压力大小呈正相关,且肌肉坏死是损伤的主要机制。展开更多
文摘Purpose:The use of tourniquet in orthopedic surgery facilitates operation by establishing a bloodless surgical field.However,many complications following the use of tourniquets have been reported.Tourniquet pain is the most common complication.This study aimed to find the actual incidence of pain associated with tourniquet use in orthopedic surgery and the various factors.Methods:It is a prospective observational study conducted on 132 consecutive cases.Patients aged 18-70 years with musculoskeletal problems of the forearm and leg requiring surgery were included in the study.Patients with open injuries or contraindications such as diabetes mellitus,compromised circulatory states,neurological deficit,compartment syndrome and unable to give informed consent were excluded.The parameters assessed included duration of tourniquet use,tourniquet pressure,type of anesthesia,any interval release of the tourniquet and reapplication after a reperfusion period,whether upper or lower limb surgery,severity of tourniquet pain,timing of tourniquet release and complications.Chi-square and non-parametric Mann-Whitney U test were used for data analysis.Results:In upper limb surgeries,if duration of surgery was less than 60 min,14(51.8%)cases experienced tourniquet pain and 13(48.1%)had no pain,and if duration of surgery was more than 60 min,24(60.0%)had pain and 16(40.0%)experienced no pain.In lower limb surgeries if duration of surgery was less than 60 min,2(7.7%)experienced pain and 24(92.3%)had no pain,and if duration of surgery was more than 60 min,14(35.8%)experienced pain and 25(64.8%)had no pain.Degree of tourniquet pain increases with the duration of surgery.Statistically,there was significant association between tourniquet inflation time and tourniquet pain in both upper and lower limbs(p=0.034 and 0.024,respectively)Conclusion:Incidence of tourniquet pain was in direct proportion to the duration of tourniquet use and was higher in cases with regional anesthesia.Other risk factors assessed including tourniquet pressure,upper or lower limb surgery,tourniquet release time and interval had no significant contribution to the incidence or severity of tourniquet pain.
文摘Background: Pneumatic arterial tourniquet is a very commonly used technique in limb surgeries to provide bloodless field to facilitate dissection and decrease blood loss. However, arterial tourniquet has many deleterious effects including hemodynamic changes, serum lactate and potassium level changes and tourniquet-induced pain which sometimes can be severe and intolerable. Aim of the study: To evaluate the effect of different regional blocks: femoral-sciatic, spinal and epidural blocks on serum lactate and potassium levels and the degree of arterial tourniquet-induced pain in patients undergoing lower limb orthopedic surgeries. Methods: 60 patients underwent lower limb orthopedic surgery with application of tourniquet for duration not more than 90 minutes. Patients were assigned randomly to one of three groups (20 each) Group I had sciatic-femoral block, Group II: patients had spinal anesthesia and Group III: patients had epidural anesthesia. Intraoperative hemodynamics, changes in serum potassium and lactate levels and tourniquet pain after tourniquet inflation & deflation, were recorded. Results: There was no statistically significant difference among the three groups regarding tourniquet pain after tourniquet inflation (p = 0.872) and deflation (p = 0.902), and regarding serum levels changes of potassium (p = 0.067) and lactate (p = 0.051). However, each group showed statistically significant increase in post deflation tourniquet pain (p = 0.003, 0.002, 0.003, in groups F, S, E respectively) and serum potassium (p = 0.004, 0.006, 0.000, in groups F, S, E respectively) and lactate levels (p = 0.004, 0.000, 0.000, in groups F, S, E respectively) when compared to the pre-deflation values, and the increase was directly proportional to the duration of tourniquet. Conclusion: the three different types of anesthesia (femoral-sciatic, spinal and epidural block) have the same effect on serum lactate and potassium levels and the degree of tourniquet pain, which were related to the duration of tourniquet inflation.
文摘目的止血带在全膝关节置换术中的应用一直存在争议。文中探讨全膝关节置换术中不同止血带压力对于患肢术后疼痛肿胀的影响,并对损伤机制进行初步分析。方法选取2017年6月-12月于南京总医院行全膝关节置换术的患者96例,按照随机数字表法将患者分为240 mm Hg(低压力)组、270 mm Hg(中压力)组和300 mm Hg(高压力)组,对患者术前及术后1~2 d的疼痛及大腿周径进行测量;同时分别于术前及术后3、8、24 h抽取血标本检测过氧化物歧化酶1(SOD1)、前列腺素E2(PGE2)、肌红蛋白,并进行比较。结果术后第1天与第2天内,低压力组与中压力组患肢疼痛差异无统计学意义(P>0.05);低压力组、中压力组与高压力组之间比较,差异均有统计学意义(P<0.05),且低压力组更加明显(P<0.01)。术后第1天与第2天内,低压力组与中压力组患者大腿周径比较差异无统计学意义(P>0.05);低压力组、中压力组与高压力组比较,差异均有统计学意义(P<0.05)。相关分析结果显示,压力与疼痛(r=0.518,P<0.01)与肿胀(r=0.345,P<0.05)均呈正相关。术后3 h内,3组在SOD1和PGE2水平差异均有统计学意义(P<0.05);在术后8 h及24 h时,低压力组与中压力组在SOD1和PGE2水平上差异无统计学意义(P>0.05);仅高压力组分别与中压力组和低压力组之间差异有统计学意义(P<0.05)。而肌红蛋白在术后3 h时,低压力组与中压力组差异无统计学意义(P>0.05)。高压力组分别与中压力组、低压力组肌红蛋白水平差异有统计学意义(P<0.05)。在术后8 h及24 h,3组之间在肌红蛋白水平上差异均有统计学意义(P<0.05)。结论患肢术后疼痛、肿胀与术中止血带压力大小呈正相关,且肌肉坏死是损伤的主要机制。
