Le garrot pneumatique d'orthopédie

Tourniquet pain in a volunteer study: effect of changes in cuff width and pressure

“…Pain from tourniquet use was first studied in 1952 [6]; a number of mechanisms has been invoked to explain its cause [4, 7]. The same sequence of pain during tourniquet inflation and deflation has been described previously in studies conducted on volunteers [5, 8].…”

“…The aetiology and neural pathways involved in tourniquet pain remain controversial, but are probably multifactorial [4]. The pain sensations described could be of neurogenic origin.…”

“…The pain sensations described could be of neurogenic origin. The classical neurogenic hypothesis was probably the most predominant one [7]. Nerve compression was classically thought to be mediated by unmyelinated, slow‐conducting C fibres normally inhibited by earlier arriving fast impulses conducted by myelinated A‐δ fibres [10, 11].…”

“…It has been demonstrated on animal models that neurophysiological (a compound of motor action potential amplitudes and nerve conduction velocity), as well as neuropathological fibre damage was correlated with tourniquet pressure [12]. Unfortunately, serious complications, such as permanent nerve palsies may occur, especially with a straight tourniquet or with high occlusive pressures [3, 4], but of course this damage is also partly as a result of a long ischaemic period. The response of spinal dorsal horn neurones to mechanical compression could be indicative of dynamic receptive field plasticity [13].…”

“…Therefore, the extremities of a limb are affected by ischaemia. On the one hand, it has been suggested that the wider the tourniquet cuff, the lower the occlusion pressure [3, 4]. On the other hand, it has also been suggested that a wider tourniquet cuff results in more pain [5].…”