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At least 19 recordsLinked to original sources
PubMedDate not supplied

Tourniquet pain: the response to the maintenance of tourniquet inflation on the upper extremity of volunteers.

This investigation examined the effect of three factors--tourniquet width, tourniquet inflation pressure, and application of the tourniquet to the left or right extremity--on the intensity of tourniquet pain and duration of tourniquet inflation, as well as the circulatory effects associated with maintenance of inflation of a pneumatic tourniquet on an upper extremity of 12 healthy, unmedicated volunteers. All subjects manifested a time-dependent circulatory response to maintenance of tourniquet inflation, characterized by increases in heart rate and systolic and diastolic blood pressure. The mean duration of tourniquet inflation was 34 +/- 13 minutes (mean +/- SD). No difference was demonstrated with respect to the width of the tourniquet, the tourniquet inflation pressure, or the application of the tourniquet to the left or right extremity on the intensity of pain or the duration of tourniquet inflation.

Arm↗
PubMed1998

Metabolic effects of a low-pressure tourniquet system compared with a high-pressure tourniquet system in arthroscopic anterior crucial ligament reconstruction.

BACKGROUND: Bloodless field is an integral part of orthopedic surgery. Use of tourniquet is associated with a risk of skeletal muscle ischemia and reperfusion injury. The purpose of this prospective, open-randomized study was to determine if the use of a tourniquet system using low pressure, with a wide, curved cuff connected to a microprocessor pump is safer than a standard tourniquet system with a narrow, straight cuff using higher inflation pressures. METHODS: Test parameters used as markers of muscular injury and anaerobic metabolism were femoral vein blood lactate, pH, pCO2, pO2, potassium, aspartate aminotransferase activity, myoglobin, creatine kinase and creatine kinase-MM activity levels after release of tourniquet. Twenty-six ASA I-II patients were studied. RESULTS: Tourniquet times varied between 30 and 144 min. Deflation of the tourniquet caused a significant release of lactate, myoglobin and potassium detected in the femoral vein blood. pCO2 increased, but pH and pO2 decreased after tourniquet deflation. There were no differences between the study groups. The tourniquet time showed a significant correlation with femoral vein lactate. CONCLUSION: The main finding of this study was that the metabolic changes were more pronounced with the longer tourniquet time. The results of the study did not show any difference on metabolic markers of muscular injury during the first hour after release of tourniquet between the two tourniquet systems.

Adolescent↗
PubMed1996

Comparison of functional deficits in the rabbit tibialis anterior following tourniquet ischemia and tourniquet compression.

The purpose of this study was to measure the contractile properties of skeletal muscle after direct compression with a tourniquet and to compare these properties with those found after a similar period of tourniquet ischemia. A rabbit model of tourniquet compression of the tibialis anterior was developed and tested for this investigation. Fifty-seven animals then were divided into four protocol groups: (a) thigh tourniquet (ischemia) at 350 mm Hg (46.7 kPa), (b) leg tourniquet (compression) at 350 mm Hg (46.7 kPa), (c) leg tourniquet at 125 mm Hg (16.7 kPa), and (d) controls. A significant decrease in maximum tetanic tension was demonstrated in all three experimental groups. Direct compression at 350 mm Hg resulted in the greatest decline in maximum tetanic tension (22.6% of control), followed by compression at 125 mm Hg (30.5%) and ischemic injury (40.2%). In addition, direct compression at 350 mm Hg resulted in a significantly greater loss of force-generating capacity when compared with the ischemic group (p < 0.01). A similar pattern was noted for the rate of rise in maximum tetanic tension. Gross histologic examination of the tibialis anterior sections was consistent with the results of functional testing, with the more severe abnormalities noted in the compressed specimens. These results clearly demonstrate that tourniquet compression injury results in a more significant loss of functional strength and contractile speed than tourniquet ischemia. Further investigations on the safe limits of tourniquet use thus should be directed toward measuring the effect of the pneumatic tourniquet on the underlying soft tissues.

Animals↗
PubMed1991

Muscle injury induced beneath and distal to a pneumatic tourniquet: a quantitative animal study of effects of tourniquet pressure and duration.

Previous recommendations regarding the "safe" period of tourniquet hemostasis were based largely on studies of ischemia distal to the tourniquet. This study quantitatively analyzed skeletal muscle injury induced beneath and distal to a pneumatic tourniquet applied to the hindlimbs of rabbits for 1, 2, or 4 hours with a cuff inflation pressure of 125, 200, or 350 mm Hg. Technetium Tc 99m pyrophosphate incorporation after systemic injection (Tc 99 uptake) and correlative histology were used to evaluate tissue damage 2 days after tourniquet application. Compared with the contralateral control limbs, compression and ischemia induced statistically significant increases in Tc 99 uptake in the thigh and leg regions of all groups. Pyrophosphate incorporation was significantly greater in the thigh region than in the leg region after 2 hours of compression in the 200 and 350 mm Hg pressure groups and following 4 hours of compression in all pressure groups. Focal and regional fiber necrosis and degeneration were observed in thigh muscles after 2 hours of tourniquet compression. Two hours of continuous tourniquet application at clinically relevant cuff inflation pressures induced significant skeletal muscle necrosis beneath the tourniquet. Use of the lowest possible inflation pressure for a limited duration should minimize the degree of tissue injury caused by tourniquet application.

Animals↗
PubMed2000

Tourniquet versus no tourniquet use in routine knee arthroscopy: a prospective, double-blind, randomized clinical trial.

PURPOSE: The purpose of this study was to determine the effects of tourniquet use for routine knee arthroscopy based on both subjective and objective functional outcome measures. TYPE OF STUDY: The study was a prospective, double-blind, randomized clinical trial. MATERIALS AND METHODS: There were 120 patients randomized to tourniquet inflation (300 mm Hg) or no tourniquet inflation during routine knee arthroscopy. Patients recorded their average pain on a visual analog scale and their narcotic use for the previous 24 hours, for the first 5 postoperative days. Patients also completed a preoperative and postoperative (2 week, 6 week, 3 month) Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 6-minute walk, 30-second stair climb, 1-leg standing vertical leap, range of motion, and isokinetic strength testing. Time to return to work and sport was documented. RESULTS: No statistically significant difference was found between tourniquet-up and tourniquet-down groups for the WOMAC quality of life measure, functional tests, isokinetic muscle strengthening, or time to return to work or sport (t test/repeated measures analysis of variance). However, there was a trend for less early postoperative pain and slightly better isokinetic strength testing at 2 weeks in the tourniquet-down group. Visualization was rated by surgeons to be 3 times better in the tourniquet-up group, although mean operative time did not differ between the groups. CONCLUSION: The use of a pneumatic tourniquet at 300 mm Hg does not significantly effect overall patient quality of life or functional outcome following routine knee arthroscopy.

Adult↗
PubMed2002

Evaluation of the World Health Organization standard tourniquet test and a modified tourniquet test in the diagnosis of dengue infection in Viet Nam.

OBJECTIVES: A positive tourniquet test is one of several clinical parameters considered by the World Health Organization to be important in the diagnosis of dengue haemorrhagic fever, but no formal evaluation of the test has been undertaken. As many doctors remain unconvinced of its usefulness, this study was designed to assess the diagnostic utility of both the standard test and a commonly employed modified test. METHODS: A prospective evaluation of the standard sphygmomanometer cuff tourniquet test, compared with a simple elastic cuff tourniquet test, was carried out in 1136 children with suspected dengue infection admitted to a provincial paediatric hospital in southern Viet Nam. RESULTS: There was good agreement between independent observers for both techniques, but the sphygmomanometer method resulted in consistently greater numbers of petechiae. This standard method had a sensitivity of 41.6% for dengue infection, with a specificity of 94.4%, positive predictive value of 98.3% and negative predictive value of 17.3%. The test differentiated poorly between dengue haemorrhagic fever (45% positive) and dengue fever (38% positive). The simple elastic tourniquet was less sensitive than the sphygmomanometer cuff, but at a threshold of 10 petechiae (compared with the WHO recommendation of 20) per 2.5 cm2 the sensitivity for the elastic tourniquet rose to 45% (specificity 85%). Other evidence of bleeding was frequently present and the tourniquet test provided additional information to aid diagnosis in only 5% of cases. CONCLUSION: The conventional tourniquet test adds little to the diagnosis of dengue in hospitalized children. The simple, cheap elastic tourniquet may be useful in diagnosing dengue infection in busy rural health stations in dengue endemic areas of the tropics. A positive test should prompt close observation or early hospital referral, but a negative test does not exclude dengue infection.

Adolescent↗
PubMed1993

The use of lower tourniquet inflation pressures in extremity surgery facilitated by curved and wide tourniquets and an integrated cuff inflation system.

Use of the lowest possible cuff inflation pressure should minimize the pathogenic effects of compression beneath the pneumatic tourniquet. Curved tourniquets (designed to fit conically shaped limbs) and wider tourniquets were associated with significantly lower arterial occlusion pressure (AOP) than standard, straight tourniquets on the arms and legs of 26 normal volunteers. These tourniquets were used with an integrated tourniquet inflation system in 29 upper-extremity and 31 lower-extremity surgeries. Mean tourniquet inflation pressures of 183.7 mm Hg and 208 mm Hg were used during various surgical procedures of the arm and leg, respectively. Incomplete hemostasis was associated with elevated systolic blood pressure in several cases, but acceptable surgical hemostasis was achieved by incremental increase of the cuff inflation pressure. Curved cuffs, wide cuffs, and an integrated cuff inflation system should facilitate the use of lower tourniquet inflation pressures in extremity surgery.

Adolescent↗
PubMed2000

Tourniquet-induced enmg changes in arthroscopic anterior cruciate ligament reconstruction. A comparison of low and high-pressure tourniquet systems.

BACKGROUND AND AIMS: The use of a tourniquet during surgery is associated with a risk of neurological disorders. We compared whether a new tourniquet system using low pressure (250 mmHg) is safer than a standard tourniquet system using higher inflation pressure (350 mmHg). MATERIALS AND METHODS: Thirty-one patients (ASA I-II), ages 16-48 years, were studied with ENMG preoperatively and 3 weeks postoperatively following arthroscopic anterior cruciate ligament reconstruction. Tourniquet times varied between 30 and 146 min. RESULTS: Postoperative slowing of motor and sensory conduction was observed, as well as an increase of the minimum peroneal F-response and tibial H-reflex latencies. The sensory amplitude of the sural nerve decreased. Vastus medialis of the quadriceps femoris muscle showed a reduced interference pattern in ENMG in maximal voluntary effort postoperatively. No differences were found in measured results between the low and high pressure tourniquet systems. CONCLUSIONS: Slight postoperative ENMG alterations were demonstrated but the use of both tourniquet systems is safe within the limit of tourniquet times of less than 2 h.

Adolescent↗
PubMed2004

The role of drains and tourniquets in primary total knee replacement: a comparative study of TKR performed with drains and tourniquet versus no drains and adrenaline and saline infiltration.

One hundred fifteen consecutive patients undergoing TKR were divided into two groups to determine whether blood loss and transfusion in total knee replacement (TKR) using adrenaline with saline infiltration would be less than TKR with tourniquet and drain. Group 1, composed of 60 patients, received 2.5 mg of 1:1000 adrenaline diluted in 500 mL of normal saline, which was infiltrated into the skin, subcutaneous tissues, and capsule before surgical incision. No tourniquets or postoperative drains were used. Group 2, composed of 55 patients, had a tourniquet and postoperative drain. Thromboprophylaxis with low molecular weight heparin also was used. Pre- and postoperative hemoglobin, blood loss, hematocrit, and transfusion requirements were studied in both groups; in group 2, blood loss in the drains also was noted. Average preoperative hemoglobin and hematocrit in the two groups were 13.7 g/dL and 39.3 g/dL, respectively, and 13.5% and 39%, respectively. Average intraoperative blood loss was 290 mL in group 1 and 377.7 mL in group 2 (P<.005). Postoperative blood loss in group 1 was <50 mL based on dressing soakage and 297.7 mL in group 2 (P<.005). Average postoperative hemoglobin and hematocrit in the two groups were 10.6 g/dL and 8.4 g/dL, respectively, and 35.4% and 31.1%, respectively. Transfusion rates were 3.3% and 23.6%, respectively (P<.005). The average volume transfused was 1.2 U. Adrenaline and saline infiltration is safe and helps reduce intraoperative blood loss. Suction drain use for surgical wounds after primary, uncomplicated TKR is questionable.

Aged↗
PubMed2003

[Novel findings from an animal tourniquet shock model].

This article is a review of our experimental results regarding the physiological statuses and roles of chemical mediators in tourniquet shock, and a novel phenomenon, modulation reflex, that is commonly observed in this shock model is discussed. In a rabbit with a tourniquet applied to a hind limb for 24 hrs, blood pressure (BP) gradually falls after release of the tourniquet, but the decline in BP stops when a tourniquet is again applied to the hind limb, indicating that shock mediators are attributed to the hind limb. The levels of dipeptides (anserine and carnosine) and lysosomes in blood samples as well as the levels of leukotrienes (LTD4 and LTE4) in blood and muscle samples from rabbits in tourniquet shock were elevated. However, injection of a large amount of a dipeptide into an ear vein of a rabbit did not reduce BP, suggesting that both peptides may not be directly related with reduction in BP of rabbits in tourniquet shock. Injection of a platelet-activating factor (PAF) antagonist into an ear vein resulted in slight elevation of BP and the elevated level was maintained for about 1 to 4 hrs during the period of decline in BP in tourniquet shock. As for interleukin-6 (IL-6), IL-6-deficient mice at young ages have a significantly greater blood volume than do wild-type mice without concomitant changes in body composition. Therefore, the role for IL-6 in the regulation of peripheral circulation may be to elevate, not reduce BP. In mice in tourniquet shock, superoxide (O2-) production is observed in skeletal muscle cells and these cells correspond to mitochondria-rich cells. However, RT-PCR of muscle samples showed no significant nitric oxide synthase (NOS) mRNA expression after tourniquet release. Pretreatment with NOS inhibitors before tourniquet release reduced O2- production in the skeletal muscle. These results indicate that O2- produced in muscle subjected to ischemia/repefusion may be involved in shock. As for changes in mRNA expression patterns of pro-inflammatory cytokines and nerve growth factors in blood samples from rats in tourniquet shock, up-regulation of M-CSF mRNA began at 2 h after tourniquet application and was short-lived. The level of ATF-3 mRNA had increased at 1 h and NGF mRNA gradually increased and reached a significantly high level at 4 h after tourniquet application. These results indicate that the transient mRNA expressions probably trigger secondary events that may be beneficial to wound repair and regeneration. In the early stage of tourniquet shock, the levels of IL-6 mRNA in the liver and kidneys of rats increased progressively and significantly, and the levels of iNOS mRNA in the kidneys increased. These findings suggest that that humoral and/or cellular mediators produced locally in the hind limb are responsible for remote organ injuries. Thus, these mediators, interacting each other, may contribute to the progress of shock. We have also found a novel phenomenon in tourniquet shock using rabbits. When a tourniquet is applied to the upper hind limb of a rabbit for 24 hrs, and pressure is applied to the femoral medial area immediately after tourniquet release, a reflex of decrease in blood pressure and decrease in heart rate, which last for a short period, is usually observed. This reflex is mediated through the ipsilateral femoral nerves, central nervous system and vagal nerves. Since the modulation reflex may be due to peripheral nerve injury, we investigated morphological and molecular changes in sciatic nerves and dorsal root ganglion (DRG) neurons in rats after tourniquet application. At 4 hr after tourniquet application, light microscopic examination showed only degeneration of the tourniquet segment in the sciatic nerve but no morphological changes in the DRG, while electron microscopic examination revealed mitochondrial swelling in some DRG neurons on the tourniquet-applied side and calcium deposition in these swollen mitochondria. These findings suggest that peripheral nerve injury induced a large amount of calcium influx into neuronal cell somas and that excess amounts of calcium-influx into neurons resulted in mitochondial swelling. Results of mRNA level analyses showed NGF mRNA expression followed by NGF protein expression in Schwann cells of the ipsilateral DRGs at 4 h after tourniquet application but not in the contralateral or control DRGs. Similarly, significantly high nNOS and iNOS mRNA levels were observed in the ipsilateral DRGs at 4 h, and expressions of nNOS and iNOS proteins were detected in the ganglion of the ipsilateral DRG. In addition, the TNF-alpha mRNA levels were significantly increased in the ipsilateral DRGs at 1 h after tourniquet application, indicating that TNF-alpha was activated in the early stage of nerve injury and then induced iNOS mRNA expression. Large amounts of nitric oxide (NO) produced by iNOS might result in damage to the host cells, and an overdose of NO might induce apoptosis and eliminate damaged cells during the early stage of nerve injury.

Animals↗
PubMed2004

Acceptability of ankle tourniquet use in midfoot and forefoot surgery: audit of 1000 cases.

BACKGROUND: While use of a thigh tourniquet with general anesthesia is widely accepted, use of an ankle tourniquet in the awake patient is more controversial. In particular, it is not clear how long patients tolerate this device or what the consequences are of intraoperative tourniquet pain. METHOD: A prospective audit was done of 1000 patients undergoing midfoot and forefoot surgery using an ankle block. We examined the intraoperative problems associated with the use of an ankle tourniquet, particularly the role and consequences of intraoperative tourniquet pain. Risk factors for tourniquet pain were statistically examined, and patient acceptance was gauged through followup questions. RESULTS: With correct application and the option of sedation, 3.1% of patients complained of tourniquet pain. In 0.4% of patients tourniquet pain necessitated a conversion to general anesthesia. A significant association was found between tourniquet pain and both age and tourniquet time. We found that for patients younger than 70 years of age, the tourniquet can be applied comfortably for up to 30 minutes in over 97%. For each 11 minutes beyond this, another 1% of patients reported tourniquet pain. However, patients 70 years or older had an average 3.5 times increase in tourniquet pain. In this age group the tourniquet can be applied comfortably for up to 30 min in 91%. For each 3.2 minutes beyond this, another 1% reported tourniquet pain. When questioned, 97.2% of our patients reported that they would have surgery again with an ankle tourniquet. CONCLUSIONS: Our audit shows that with correct application and the option of sedation the ankle tourniquet is well tolerated by most patients. However, clinicians need to be mindful that patients 70 years of age or older are at greater risk of tourniquet pain and that in all patients the risk of tourniquet pain gradually increases when application times exceed 30 min.

Adolescent↗